The Strategic Framework
for Malaria Communication at the Country Level
2012–2017
Copyright© 2012 Roll Back Malaria Partnership
The Roll Back Malaria Partnership (RBM) is the global framework for coordinated
action against malaria. Founded in 1998 by UNICEF, WHO, UNDP, and the World
Bank and strengthened by the expertise, resources, and commitment of more than
500 partner organizations, RBM is a public-private partnership that facilitates the
incubation of new ideas, lends support to innovative approaches, promotes high-level
political commitment, and keeps malaria high on the global agenda by enabling,
harmonizing, and amplifying partner-driven advocacy initiatives. RBM provides policy
guidance and secures financial and technical support for control efforts in countries
and monitors progress towards universal goals. The RBM Secretariat is hosted by the
World Health Organization in Geneva, Switzerland.
The geographical designations employed in this publication do not represent or imply
any opinion or judgment on the part of the Roll Back Malaria Partnership on the legal
status of any country, territory, city or area, on its governmental or state authorities,
or on the delimitation of its frontiers. The mention of specific companies or of certain
manufacturers’ products does not imply that they are endorsed or recommended by
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not mentioned or represented.
This document may be freely reviewed, quoted, reproduced and translated, in part or in
full, provided that the source is acknowledged.
The authors are grateful to all of the organizations and individual photographers who
granted permission for their photos to be used in this publication. Photo credits are on
the inside back cover. Permission to reproduce any of these photos can only be granted
by the original owners.
Cover explanation:
In the top picture, school children in Tanzania learn how to hang Long-lasting
Insecticide Treated Bed Nets (LLINs). The four pictures across the bottom represent
the major malaria interventions: (L to R) Indoor Residual Spraying (IRS), intermittent
preventive treatment for pregnant women (IPTp), use of LLINs, and diagnosis and
treatment of malaria with appropriate anti-malarial medication.
The Strategic Framework
for Malaria Communication at the Country Level
2012–2017
Table of Contents
Acknowledgements
iv
List of Acronyms
v
Preface
vi
Executive Summary
vii
Background – Rationale for and Purpose of this Framework
1
Achieving the Twin Goals of Access and Use
1
The Evolution of Communication Challenges over Time
3
Committing to Improved Communication for Malaria
4
The Role of Communication in Achieving Malaria Control Impact
and Principles of Effective Programs
7
Communication as a Vital Tool in Malaria Programs
7
Common Terms and Concepts
7
Principles of Effective Communication Programs
9
Strategic Framework for Advancing the Contribution and
Quality of Communication
15
Ensure Political Commitment for Communication
15
Improve Capacity and Coordination at Country level
16
Provide Support at the Global and Regional Levels
18
Build a Community of Practice in Malaria Communication
18
Incorporate Systematic Communication in Country Malaria Programs
19
Global Communication Research Agenda
28
RBM Communication Working Group
32
Conclusion
35
Annex: Communication Toolkits and Resources
37
Bibliography
43
The Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE iv
Acknowledgements
The Strategic Framework for Malaria Communication at the Country Level (Strategic Framework) was compiled and
written by Renata Seidel, Thaddeus Pennas, Tara Kovach, Phillis Kim, Beatie Divine, Martin Alilio, Hannah Koenker,
Silvio Waisbord, Prudence Smith, and Patricia Choi. It was also reviewed by the extended editorial team listed below.
The Strategic Framework builds on the work and contributions of many people and is partly derived from existing
strategic communication documents and guidelines developed by members of the Roll Back Malaria Partnership.
These have been credited where appropriate. Particular thanks go to the following individuals for their contributions
to the planning and review of this document:
Ben Adika, FHI 360/C-Change, Kenya
Robert Ainslie, Johns Hopkins University, Center for
Communication Programs
Daniso Mbewe, Southern Africa RBM Network,
Botswana
Fortunate Manjoro, National Malaria Control, Zimbabwe
Abdillah Ali, National Program Against
Malaria, Comoros
Kaendi Munguti, United States Agency for International
Development, Kenya
Constance Bart-Plange, National Malaria Control
Program, Ghana
Oscar Ntakarutimana, Population Services International,
MCH Coordinator, Burundi
Carol Baume, Consultant
Ferdinand Ntoya, FHI 360/C-Change, DRC
Hannah Bowen, Malaria No More
Bukuru Pamphile, Ministry of Public Health and AIDS
Control, Burundi
Marc Boulay, Johns Hopkins University, Center for
Communication Programs
Andrea Brown, Johns Hopkins University, Center for
Communication Programs
Valentina Buj, United Nations Children’s Fund
Philippe Rougier, The Mentor Initiative
Melanie Renshaw, African Leaders Malaria Alliance
Zahara Ali Said Salim, National Program Against
Malaria, Comoros
Mary Byangire, National Malaria Control
Program, Uganda
James Sang, Division of Malaria Control, Kenya
Soonyoung Choi, International Federation of the Red
Cross, Kenya
Daniel Somah, National Malaria Control
Program, Liberia
Joaquim Da Silva, East African Regional
Network–RBM
Roland Suomie, EQUIP, Liberia
Johanna Simon, Malaria No More
Fabio Friscia, United Nations Children’s Fund
Gladys Tetteh, CDC’s PMI Resident Advisor
to Kenya
Shoa Girma, FHI 360/C-Change, Ethiopia
Boi-Betty Udom, RBM Secretariat
Steven Harvey, Johns Hopkins School of Public Health,
Department of International Health
Daniel Wacira, United States Agency for International
Development, Kenya
Michel Itabu Issa, National Malaria Control
Manager, DRC
Pauline Wamulume, National Malaria Control Program,
Zambia
Elizabeth Juma, Division of Malaria Control, Kenya
Owembabazi Ndyanabo Wilberforce, Health
Partners Uganda
Megan Littrell, Population Services International
Kojo Lokko, Johns Hopkins University, Center for
Communication Programs, Uganda
Rebecca Young, Malaria No More, Tanzania
Susan Zimicki, FHI 360
Special thanks to the President’s Malaria Initiative, United States Agency for International Development (USAID),
and the Roll Back Malaria Partnership Secretariat for their steadfast technical and financial support for the
process and drafting of this document.
The Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE v
List of Acronyms
ACADA Assessment, Communication Analysis, Design, Action
ACSM
Advocacy, Communication, and Social Mobilization
ACT
Artemisinin-based Combination Therapy
AMP
Alliance for Malaria Prevention
AMREF
African Medical and Research Foundation
ANC
Antenatal Care
BCC
Behavior Change Communication
C4D
Communication for Development
CDC
U.S. Centers for Disease Control and Prevention
CHW
Community Health Worker
CMD
Community Medicine Distributor
GFATM
The Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria
GMAP
Global Malaria Action Plan
JHU-CCP
Johns Hopkins University-Center for Communication Programs
HHHousehold
IEC
Information, Education, and Communication
IMCI
Integrated Management of Childhood Illness
ITN
Insecticide-treated Bed Net
IPC
Interpersonal Communication
IPTp
Intermittent Preventive Treatment for Pregnant Women
IRS
Indoor Residual Spraying
LLIN
Long-Lasting Insecticide Treated Bed Nets
MOH
Ministry of Health
M&E
Monitoring and Evaluation
NGO
Non-governmental Organization
NMCP
National Malaria Control Program
OR
Operational Research
PATH
Program for Appropriate Technology in Health
PMI
US President’s Malaria Initiative
RBM
Roll Back Malaria
RDT
Rapid Diagnostic Test
SBCC
Social and Behavior Change Communication
SP
Sulfadoxine-pyrimethamine
UNICEF
United Nations Children’s Fund
USAID
United States Agency for International Development
WHO
World Health Organization
The Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE vi
PREFACE
Systematic communication to bring about sustained changes in social norms and behaviors
is increasingly understood as integral to malaria control programs. Credit is due to the Roll
Back Malaria Partnership, The Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria, the
Bill and Melinda Gates Foundation, the President’s Malaria Initiative (PMI), USAID, and other
donors for recognizing that greater urgency is needed in developing and carrying out effective
communication plans in order to improve the impact of prevention and treatment efforts. We are
honored to present to all of the partners The Strategic Framework for Malaria Communication at the
Country Level, which outlines clear priorities for strengthening country capacity, honing program
strategies, and sharing best practices of evidence-based communication as part of our work to
control, eliminate, and ultimately eradicate malaria.
An increasing wealth of experience points to the importance of this program component. Results
from Senegal indicate that intensified communication interventions and major nationwide
advocacy efforts—coupled with an expansion of bed net distribution, introduction of rapid
diagnostic testing, and health system strengthening—contributed to a 30% reduction in underfive mortality since 2001, saving more than 26,800 children (Mouzin et al. 2010). Other countries
are also demonstrating the value of communication in mobilizing political support, improving
interactions between caregivers and health workers and building trust, and engaging local leaders
and communities in malaria prevention and treatment strategies.
Much work still needs to be done. At this point in the almost 50-year fight against malaria, we
need to focus on ensuring that evidence-based communication is positioned as a core component
of global and national malaria control policy and is allocated the resources necessary to contribute
to health impact.
This document charts a Strategic Framework for ensuring that communication is placed high
on the agendas of malaria policy makers and national malaria control strategies in line with the
Global Malaria Action Plan (GMAP). The framework provides for significant steps forward, and for a
change in both ambition and innovation in tackling malaria.
We want to personally thank all of the partners and national malaria control programs for
contributing their time, energy, and wisdom. This framework is a testament to their hard work,
careful thought, debate, and consensus and it serves as a much-needed roadmap for positioning
communication as essential to our fight against this deadly disease.
Dr. Fatoumata Nafo-Traoré
Executive Director
Roll Back Malaria Partnership
Rear Admiral Timothy Ziemer
U.S. Global Malaria Coordinator
President’s Malaria Initiative
Executive Summary
PAGE vii
EXECUTIVE SUMMARY
A significant scaling up of systematic communication
and behavior change efforts will be needed to achieve
the global targets for malaria control as detailed
in the Roll Back Malaria (RBM) Partnership Global
Malaria Action Plan for a Malaria-free World (2008).
In 2011–2012 a group of communication-oriented
partners, national malaria control managers, and
members of the RBM Partnership Secretariat met
several times (in Geneva, Switzerland; Washington,
DC; Nairobi, Kenya; and Accra, Ghana) to examine
the current state of the art in health communication
and articulate a The Strategic Framework for Malaria
Communication at the Country Level.
The meetings aimed to begin a process of mobilizing
political, social, and financial resources to position
communication as a core component of malaria
control and foster the development of more effective
communication programming at the country level.
The Strategic Framework, drafted through a
consensus process, focuses on the need to address
five challenges to malaria control as stated in the RBM
Global Malaria Action Plan. These challenges are to:
The Strategic Framework sets out an agenda for
ensuring state-of-the-art health communication
plays a stronger role in improving the impact of the
global malaria control effort. It defines a common
vision and goals for improving the effectiveness of
malaria communication programs and recommends
operations research to build a stronger evidence base
for effective approaches.
. KEY ACTIONS
The Strategic Framework describes complementary processes needed to improve the contribution of communication to malaria control.
It seeks to mobilize partners in the malaria
community to take the following key actions:
• Advocate for systems and programs that
ensure communication is positioned
appropriately within the global RBM
Partnership
• Improve the acceptance and use of long-
• Ensure all national malaria control
program communication strategies are
context-appropriate, evidence-based, and
results-driven
• Accelerate access to and demand for intermittent
• Foster capacity building in communication
planning, management, and evaluation at
the global, regional, national, and subnational levels
lasting insecticide treated bed nets (LLINs),
particularly for children under five and
pregnant women
preventive treatment for pregnant women (IPTp)
• Improve early treatment seeking and compliance
with drug therapy (Artemisinin-based
Combination Therapy — ACTs)
• Increase acceptance of indoor residual spraying
(IRS) as a tool in vector control
• Strengthen a culture of malaria prevention and
treatment-seeking behavior
• Mobilize political commitment and resources
for malaria and for country level communication
efforts
• Invest adequate resources to ensure
communication interventions achieve
measurable results at the country level
• Expand the evidence base demonstrating
the impact of communication
interventions on social and behavioral
change and thus contribute to the
reduction of the burden of malaria
The Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE viii
Intended audiences for this document are:
• Technical staff at global, national, and local levels
charged with developing, funding, reviewing,
evaluating, and/or implementing malaria
prevention and control policy, strategies, and
approaches.
• RBM communication-oriented partners engaged
in developing, implementing, and evaluating
communication programs/projects and who
contribute to the global discourse on effective
approaches to communication.
The document is divided into three major parts:
Background—Rationale and Purpose of the
Framework
• Describes the challenges of improving appropriate
utilization of malaria prevention and treatment
interventions
• Describes the rapid pace of communication
challenges over time and the need for an
expanded evidence base
“Service delivery in malaria is not only about
delivering products; it is also about ensuring
they are used properly. <Communication>
methodologies are essential to ensure the
appropriate use of interventions.”
— Global Malaria Action Plan
• Outlines a vision and goals for making
communication an integral part of malaria control
• Outlines the gaps in the current malaria
communication structure and obstacles to
effective programming
The Role of Communication in Achieving Malaria
Prevention and Control Impact and Principles of
Effective Programs
• Outlines the range of ways communication can
improve the impact of malaria programs
• Defines important terms and concepts of
communication (including four principles
underlying effective programming)
Mothers in Kaolack, Senegal, happy to have just received packaged LLINs to protect them and their families.
Executive Summary
PAGE ix
Strategic Framework for Advancing the
Contribution and Quality of Communication
• Presents the case for increasing political
commitment to communication in malaria
programs
• Suggests approaches for improving capacity
and coordination of communication for malaria
programs at the global and country levels
• Describes the major elements of evidence-based
1
communication in country malaria programs
• Recommends development of and consensus on
an operational research agenda for improving the
evidence base
• Promotes development of a community of practice
for sharing experiences and advancing the state of
the art in communication for malaria control
• Recommends support for, and outlines
responsibilities of, an RBM Communication
Working Group
Actions taken to support the complementary
elements of the Strategic Framework outlined in
the last section of this document will help establish
evidence-based communication as an integral part
of malaria program scale up, sustained control, and
elimination and improve the impact of these efforts.
Four indicators are proposed for the next five-year
period as appropriate measures of progress toward
this overarching objective:
• NMCPs in 80% of high-burden countries
have
created and implemented evidence-based,
national communication strategies
2
Communication practitioners use the term “evidence-based” to indicate strategies are based on quantitative and qualitative research
at designated points in a program. However, “evidence-based” is
also used in this document in the more familiar (or clinical) way to
mean a specific intervention has been proved to be effective under
specific conditions.
2
The 35 countries that account globally for ~98% of malaria death
are termed “high burden”; 30 of these are located in sub-Saharan
Africa (World Malaria Report 2011).
1
A child in Tanzania receives treatment with an ACT.
• 80% of high-burden countries are routinely
allocating resources in their malaria control
budgets to communication interventions
• RBM communication partners regularly generate
and disseminate evidence of communication
impact including for priorities outlined in an
agreed on global communication research agenda
• Within one year, the RBM Partnership has
established a community of practice and database
that maps partners in the majority of high-burden
countries in order to facilitate partner collaboration
Achievement of these goals will contribute to a
reduction in the intolerable burden of malaria
morbidity and mortality in these countries.
The concluding section of the strategy includes
recommendations for next steps and indicates ways
in which progress will be measured.
Background – Rationale for and Purpose of this Framework
PAGE 1
BACKGROUND
Rationale for and Purpose of
this Framework
Achieving the Twin Goals of
Access to, and Use of, Services
and Commodities
Nearly half of the world’s population is at risk for
malaria. The World Health Organization stated that
an estimated 216 million cases of malaria and more
than 655,000 deaths due to the disease had occurred in
2010. Of those who died, 86% were children under the
age of five. In endemic countries, malaria remains
the leading cause of maternal mortality and one of
the primary causes of neonatal deaths. (WHO 2011)
Global and country commitment, along with
unprecedented levels of funding, has helped reduce
the intolerable burden of malaria in many countries
in recent years. Overall, malaria-related mortality
has dropped 25% since 2000. Progress has depended
on the introduction of effective technologies and new
drugs and massive efforts to make commodities
accessible to those who are vulnerable. While access
continues to improve, however, the equally challenging
. MULTIPLE COVERAGE
DEFINITIONS
For malaria prevention interventions, coverage
means:
Long-Lasting Insecticide Treated Bed Nets
(LLINs): A household owns one long-lasting
insecticide treated bed net for every two people
living there and residents use them each night
Indoor Residual Spraying (IRS): The
interior walls of every house that is targeted is
routinely sprayed at appropriate intervals with
an effective insecticide
Intermittent Preventive Treatment (IPTp):
A pregnant woman living in a high transmission setting receives at least two doses
of an appropriate anti-malarial drug during
her pregnancy
Other vector control measures: Other
targeted approaches (e.g., larviciding,
environmental management, etc.) are applied
wherever appropriate based on scientific
evidence
For case management of malaria, coverage
means:
Diagnosis: A patient with fever receives
prompt parasitological confirmation by
microscopy or rapid diagnostic test (RDT)
of malaria diagnosis
A health worker in rural Tanzania explains how to take the proper
dose of ACT at the proper time to a young boy with malaria.
Treatment: all confirmed uncomplicated cases
of plasmodium falciparum are treated within
24 hours with ACTs
The Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE 2
tasks of creating demand for products and services,
ensuring appropriate use, and fostering changes in
underlying social norms related to prevention and
treatment of the disease remain daunting.
Increasing coverage—especially among those at
highest risk who are often the poorest and most
marginalized—requires strategically designed
communication approaches tailored to local contexts.
The Roll Back Malaria Global Malaria Action Plan
(GMAP) outlines three stages on the path toward an
ultimate goal of worldwide elimination of malaria.
These are scaling-up for impact (or SUFI), sustained
control, and country-by-country elimination. The
near-term target, SUFI, is defined as universal
coverage of appropriate interventions for all
populations at risk, supported by strengthened health
systems (RBM 2008). (See box on previous page.)
For each of these priority interventions, current data
highlight the challenges of closing gaps between
access and use:
• In sub-Saharan Africa, the number of ITNs
delivered by manufacturers increased
dramatically from 5.6 million in 2004 to 145
million in 2010. The proportion of households
owning at least one ITN in sub-Saharan Africa is
estimated to have risen from 3% in 2000 to 50%
in 2011. Analysis of household surveys indicates
that use of ITNs has also increased, but this varies
greatly by country. In 13 countries in the African
Region for which household survey data were
available for 2008-2011, use the previous night
(by pregnant women and children under five)
varied from under 10% in Nigeria and Zimbabwe,
THE HIGH COST OF LOW UTILIZATION
Increased utilization of both prevention
and treatment interventions is necessary to
decrease malaria morbidity and mortality.
The cost savings associated specifically with
improved prevention behaviors were calculated for the GMAP:
“….Appropriate utilization of preventive
interventions is a key driver of treatment
costs. For example, increasing operational
effectiveness of LLINs and IRS from their
current field effectiveness of 50-60% up to 98%
can theoretically reduce incidence and therefore treatment costs, by almost 50%. Modeling
a 98% effectiveness rate showed a potential
cumulative savings globally of US$ 960
million from 2009-15. This makes a powerful
argument for investing in communication
and behavior change programs.”
— Global Malaria Action Plan
to between 46% and 64% in Madgascar, Rwanda,
Sao Tome and Principe, Tanzania, and Uganda.
(WHO 2011 and ICF International 2012)
• By the end of 2010, a total of 35 of 45 sub-Saharan
African countries had adopted IPT for pregnant
women (IPTp) as national policy. In 12 countries
in the African Region for which household
survey data were available for 2008-2011, the
percentage of women who received two doses of
IPTp during pregnancy ranged from under 15% in
Madagascar, Nigeria, and Sierra Leone, to over
66% in Zambia. (WHO 2011 and ICF International
2012)
• The number of ACT treatment courses procured
Production of LLINs has increased dramatically over the last decade.
by the public sector increased from 1.2 million
in 2005 to 181 million in 2010. In addition, a total
of 35 million treatments were estimated to have
been procured by the private sector in 2010. In
11 countries in the African Region for which
household survey data were available for 20082010, the percent of children under five having a
fever who were treated with an anti-malarial of
Background – Rationale for and Purpose of this Framework
PAGE 3
community acceptance and willingness not to
wash or re-plaster walls following spraying.
A 2012 meta-regression analysis of published
studies found that there is a need for better
understanding of the situational contexts
behind different levels of success related to IRS
campaigns. (WHO 2011 and Kim et al. 2012)
Malaria Rapid Diagnostic Tests (RDTs) at a rural clinic in Ethiopia.
any kind within 24 hours ranged from under 10%
in Rwanda, Senegal, and Sao Tome and Principe
to 41% in Tanzania. In nine of these countries,
fewer than 5% of children received ACTs within
24 hours. Many patients/caregivers purchase less
expensive and ineffective (and sometimes fake)
treatments, especially from the private sector.
(WHO 2011, RBM 2008, and ICF International 2012)
• The introduction of Rapid Diagnostic Tests (RDTs)
to confirm malaria diagnoses has the potential to
improve treatment and reduce inappropriate use
of drugs. Recent WHO guidelines recommend a
universal “test and treat” strategy for malaria,
mainly by use of RDTs. In 2010, a total of 48
countries reported deployment of RDTs at the
community level; 11 million patients were tested
in that year. Although the number of RDTs
supplied by manufacturers has continued to
increase, fewer than 50% of suspected malaria
cases handled in the public sector were tested in
the African region in 2011. Furthermore, data from
a limited number of countries suggest that both
microscopy and RDTs are less widely available in
the private sector. As access to RDTs increases,
program managers will need to understand
what the most important benefits and perceived
barriers are, from the point of view of both
providers and clients, to this new treatment
regimen. (WHO 2011)
• A total of 185 million people were protected by IRS
in 2010, representing 6% of the global population
at risk. The number of people protected by IRS
in the African Region increased from 10 million
in 2005 to 78 million in 2010. Use of IRS requires
The Evolution of Communication
Challenges over Time
A Constantly Evolving Disease
Threat — and Rapidly Changing
Responses
Each of these interventions is complex and all
have evolved in substantial ways in the last decade.
Bed nets requiring periodic retreatment are now
being replaced by LLINs; multiple distribution
and subsidy mechanisms are being introduced in
different countries. Drug resistance has led to
changes in policies, products, and treatment
regimens virtually everywhere in the last decade.
Insecticide resistance is a growing concern and is
likely to require introduction of new products. The
focus on different providers of malaria services is
also shifting along with efforts to get first-line
treatments and rapid diagnostic tests into
communities. Many countries are giving community
volunteers greater roles and also recognizing that the
private sector is a major player in malaria control.
These rapid changes have made communication
with different groups both urgent and increasingly
complicated. Few public health priorities have
required, and will continue to require, such rapid
evolution of critical information and messages for
an array of different audiences.
Success — A Constantly
Moving Target
The hoped for advances in controlling malaria
represented in the three phases outlined in the
GMAP also suggest the need for major shifts in
communication approaches as countries move
from scale-up of interventions to sustained malaria
control and, many hope, elimination of the disease.
Attitudes about the threat of malaria and the urgency
The Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE 4
of appropriate actions have already changed and will
continue to change. Complacence can undermine
maintenance of important practices within the health
system and the home, as well as commitments at the
policy level. Lessons from diarrheal disease control
have taught us that important coverage gains can
disappear even after new treatment strategies are
initially accepted by large percents of the population.
(See box below.)
. SUSTAINED CONTROL —
A CAUTIONARY TALE
For countries approaching large-scale
adoption of malaria prevention and
treatment practices, experience in diarrheal
disease control provides a cautionary tale.
Child mortality rates due to diarrhea
have remained unchanged for more than
a decade. This is despite introduction in
the 1970s of what The Lancet then termed
“potentially the most important medical
advance this century.” In the 1970s and
1980s, the introduction of the first packaged
oral rehydration salts (ORS), together with
programs that brought about significant
changes in both provider and caregiver
practices, resulted in major reductions in
child deaths in many countries.
However, funding for child survival in
general began to decrease in the 1990s.
The introduction of IMCI also lessened
the focus on community and family
involvement in diarrheal disease. ORS use
rates stagnated or decreased. According to
data from 2005-2008, only 33% of children
with diarrhea in the developing world were
given ORS. These data contrast with usage
rates in the 1980s reaching nearly twice
that in some countries. Although ORS
is inexpensive, well known, and widely
available, the communication challenges
associated with childhood diarrhea have
continued to evolve over time—and lack of
attention to this complex array of factors can
now be clearly seen in lives lost.
Changes in Communication
Technology — A Qualitative Shift
Increasing availability, even among some of the
poorest communities, of information communication
technologies, or ICTs (such as mobile phones with
voice, SMS texting, and even video capability) together
with social media have revolutionized the speed, cost,
and especially the control of communication. Even
remote groups can be reached virtually instantly and in
any language. Most importantly, communication takes
place increasingly through horizontal, rather than
vertical channels. Consumers and clients can now
be the creators of messages as well as the receivers.
Information (as well as misinformation) can go “viral”
in a flash. Understanding access to these new tools
in countries with rapidly changing ICT environments,
and harnessing their power effectively in collaboration
with a multitude of potential new partners (many
in the private sector), is a challenge shared by all
communication programs.
Committing to Improved
Communication for Malaria
Evidence of “what works” in terms of communication,
and under what conditions, would be of tremendous
value to programs needing to make cost effective
investments to improve their malaria control results.
Lack of adequate evidence to chart the way forward
in different contexts has caused some to question the
utility of communication in malaria programs. In
addition to the challenges mentioned above, however,
a number of factors at the international, national,
and community levels have been responsible for gaps
in the current malaria communication structures
and approaches. (See box on next page.) Further, the
Sources: ICF International 2012, The Lancet
2(8084):300, UNICEF/WHO 2009.
Mobile technology allows sharing of critical health information in
Mozambique.
Background – Rationale for and Purpose of this Framework
PAGE 5
THE VICIOUS CYCLE OF LOW STATUS, LOW FUNDING, AND LACK OF EVIDENCE
Lack of funding for communication in
national malaria programs has limited
the development of capacity as well as
the building of an evidence base for
improved strategies and commitment.
Gaps at different levels include:
International level
• Lack of understanding and attention to
proven communication interventions,
leading to an absence of guidelines and
tools to support country efforts
• Lack of a global coordinating mechanism
such as a Communication Working Group
• Insufficient operations research to
identify best practices and document
lessons learned
• Insufficient evidence regarding the
• Differing priorities and lack of harmonization among partners and integration with
national health education services
• Over-reliance on one-time promotional
events and mass media at the expense of
interpersonal and community mobilization strategies
• Lack of sustained approaches using
multiple channels (schools, workplace,
women’s groups, etc.)
• Failure to evaluate communication contributions to malaria program objectives
Community level
• Missed opportunities to ensure the
participation of local political, religious,
and traditional leaders in information
dissemination and mobilization
range of determinants associated with
key interventions
• Insufficient insights drawn from commu-
• Insufficient evidence of effectiveness of
• Insufficient focus on marginalized popu-
particular channels, messages, or types of
integrated approaches
• Lack of consistent use of limited data to
determine behavior and attitude patterns
in the highest risk populations
• Lack of monitoring and evaluation
indicators to inform planners of results
National level
• Traditional low status and low priority
given to communication leading to lack of
resources and appropriate structures/staff
with technical capacity
• Poor capacity to engage in behavioral
and social research into household and
community behaviors and dynamics—
leading to untargeted and purely
“promotional” messages
nity leaders and grassroots efforts
lations that are often most at risk
• Lack of integration of malaria
communication activities with other
health programs (HIV/AIDS, IMCI, RH)
• Insufficient attention paid to participatory
methodologies, especially in the development of messages
• Insufficient communication efforts
targeted for home-based care and service
providers
— Adapted from the Global Malaria Action Plan
The Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE 6
A woman in the Philippines and her unborn child are protected from malaria by an LLIN.
absence of good data (including meta-analysis)
about “what works” has created a vicious circle
for those advocating for increased priority and
investment for communication.
In 2011–2012, building on earlier efforts, a small
group of communication implementing partners
(national malaria control programs, donors, the RBM
Partnership Secretariat, UNICEF, the Global Fund to
Fight AIDS, Tuberculosis, and Malaria, the President’s
Malaria Initiative, and other technical agencies)
engaged in a series of meetings, online discussions,
and conference calls to review the current state of
communication and begin the development of a Global
Strategic Framework for Malaria Communication at the
Country Level. Participants laid out the following goal
and objectives for the Strategic Framework:
Goal
Communities are empowered to remove the
threat of malaria to human health. To achieve
this vision, global malaria policy makers, NMCPs,
and partners ensure communication is a funded,
core component of any malaria control strategy
and that communication is effectively planned,
implemented, evaluated, and revised based on
evidence and best practices.
Objectives
Over the next five years, international and national
partners will advocate for and provide the resources,
training, and expertise to ensure the following:
• NMCPs in 80% of high-burden countries have
developed and implemented evidence-based,
national communication strategies
• 80% of high-burden countries are routinely
allocating resources in their malaria control
budgets to communication interventions
• RBM communication partners regularly generate
and disseminate evidence of communication
impact, including for priorities outlined in an
agreed-on global communication research agenda
• Within one year, the RBM Partnership has
established a community of practice and
database that maps partners in the majority of
high-burden countries in order to facilitate
partner collaboration
Achievement of these goals will contribute to a
reduction in the intolerable burden of malaria
morbidity and mortality in these countries.
The Role of Communication in Achieving Malaria Control Impact and Principles of Effective Programs
PAGE 7
The Role of Communication in
Achieving Malaria Control Impact
and Principles of Effective Programs
Communication as a Vital Tool
in Malaria Programs
Well-planned and executed communication programs
can contribute to achieving malaria prevention and
treatment goals in a wide range of ways. The focus
of contributions will vary depending on the nature of
challenges presented by specific interventions, for
specific populations, within specific contexts. The
first step in communication planning is to analyze and
select these priority challenges. As mentioned in the
previous section, these are constantly evolving due
to various factors. As programs advance, the human/
social challenges also continue to shift.
A number of typical ways in which communication
can contribute to malaria programs at different
times and to varying degrees are delineated in
the box on the next page. These contributions can
be seen as underlying changes in critical groups
that are planned to lead ultimately to the last set
of bullets: improvements in specific prevention
and treatment behaviors. These outcomes in turn
have an impact on malaria morbidity and mortality.
Behavior maintenance over time (rather than onetime trial or intermittent practice) by all priority
groups is the overarching goal, so that perceptions of
“what others are doing” and “what is the right thing
to do” eventually become powerful motivations in
themselves. Effective communication strategies also
contribute to these shifts in social norms.
Common Terms and Concepts
Communication
This document uses communication as an
overarching term to describe a planned process for
influencing actions or responses among specific
groups of people. Health communication as it
has evolved as a field is distinguished from pure
Mothers in Senegal show vouchers for LLINs that they are preparing to redeem at a mass distribution.
Global Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE 8
Illustrative Ways Communication Can Contribute
to Program Effectiveness
Facilitate adoption of new policies:
• elimination of taxes and tariffs on anti-malarials
in order to reduce the costs of products
• introduction of more effective drugs for case
management and IPTp
• improving access to effective drugs through
community-based providers
• ensuring environmentally sound approaches to
malaria prevention and related products
Build awareness:
• of malaria as a dangerous disease
• of the danger of infection during pregnancy
• of available prevention and treatment products/
services and service providers
• acceptance of community-based providers
Improve prescription practices and effectiveness
of counseling:
• correct prescriptions given by health providers,
private drug sellers, community-based providers
• helpful counseling on drug dosage and duration
of treatment and what to do if treatment fails
• correct referral practices
Improve motivation of families, communities,
and providers:
• providers and clients/caregivers are mutually
respectful
Reduce barriers:
• malaria is preventable and treatable
• family decision makers support early treatment
of childhood fever and pregnant women in going
to ANC
• convulsions are a sign of severe malaria rather
than witchcraft or mental illness
• community members provide transport for
dangerously ill children
Increase knowledge:
Manage unforeseen events:
• malaria is caused by a night-biting mosquito
• dispel rumors about products
• ITNs can kill mosquitoes
• convey information quickly when an intervention
is delayed
Change perceptions/beliefs:
• fever must be treated (or tested via RDT) within
24 hours
• the full dose of an anti-malarial should be taken
in order to be effective
• a minimum of two doses of IPTp during
pregnancy protects both baby and mother
INCREASE APPROPRIATE UTILIZATION OF
PRODUCTS/SERVICES:
• caregivers seek treatment for child’s fever within
24 hours
Increase demand for products and services:
• caregivers accept RDT use and adhere to correct
treatment instructions for ACTs
• purchase ITN or exchange voucher, according
to local delivery channels
• pregnant women and children under five sleep
under an ITN each night
• attend ANC early in pregnancy and return for
additional visits
• pregnant women obtain a minimum of two doses
of IPTp (the first dose right after quickening)
• seek care for malaria symptoms from
appropriate providers
• families accept IRS spray persons into the home
and don’t wash or replaster walls
Improve acceptance and trust within the family
and the community:
These different categories can be seen as
supportive changes needed to varying degrees
in different contexts, ultimately leading to the
last set of bullets: improved prevention and
treatment behaviors.
• acceptance of IRS spray persons into the home
• acceptance of net hangers/demonstrators into
the home
Background – Rationale for and Purpose of this Framework
PAGE 9
information exchange by: 1) the setting of explicit,
measureable objectives, and 2) articulation of a theory
and pathway through which those objectives can be
achieved.3 1
These various approaches represent an evolution
in thinking about the need to engage individuals
and communities in the process of understanding
problems and defining locally-appropriate solutions.
As the field has grown, practitioners have used
different terms to describe such a process toward
achieving desired changes. This accounts for
the variations in terminology used over time in
donor guidelines and country plans. Information,
education and communication (IEC) is broadly
defined as providing knowledge to help individuals,
families, groups, organizations, and communities
play active roles in improving and protecting their
health. Behavior change communication (BCC)
methodologies emphasize analysis of behaviors and
their determinants (or underlying causes) as the
basis for science-based approaches for message
and strategy design. This term evolved into SBCC
(or social and behavior change communication) to
highlight the ultimate goal of sustained change
throughout a community or society due to a shift in
accepted norms—including factors that may underlie
multiple behaviors (as is the case with gender norms).
Advocacy, Communication, and Social Mobilization
(ACSM) are seen as complementary approaches in
a model developed by UNICEF. Communication for
Development (C4D) emphasizes the use of dialogue
and participation as part of planned processes to affect
behavior and social change. Socio-ecological models
of change have been put forward to emphasize the
interrelationships between changes at different levels
of a system and given culture.
The state of the art has advanced because of
discussions about these different models. However,
the differences in terminology are not as important
as what these models have in common. Too often
communication activities still fail to meet the
basic requirements of effective programs: i.e.,
measureable objectives and logically articulated
paths for achieving them.
Principles of Effective
Communication Programs
Effective communication programs are characterized
by a number of best practices. Four are outlined below.
Principle 1: Effective Communication
is a Systematic and Evidence-based
Process
Effective communication programs are described as
evidence-based because they build on research with
the target audience. Data are collected at various
points to ensure approaches are unfolding as planned
and objectives are met.4 3 2
Research about target audiences is conducted:
1. In the formative or developmental stage of an
intervention (using various qualitative methods
to understand beliefs, preferences, constraints,
motivations, and current behaviors)
2. To pretest concepts and materials
3. After program launch and throughout the program
to monitor processes
4. To evaluate impact and analyze the reasons
strategies have succeeded or failed (through
quantitative methods such as knowledge, attitude
and practice surveys, mystery client surveys, etc.),
as well as qualitative methods
A community worker in Senegal explains how a net can be hung in
different ways.
Communication practitioners use the term “evidence-based” to
indicate strategies are based on quantitative and qualitative research
at designated points in a program. However, “evidence-based” is
also used in this document in the more familiar (or clinical) way to
mean a specific intervention has been proved to be effective under
specific conditions.
4
See Obregon and Waisbord (2012) and NIH and CDC (2004) for additional discussions of the definition of health communication and
social and behavior change communication.
3
The Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE 10
FIGURE 1: Systematic and Iterative Communication Planning Process
RE-PLAN
RE-ASSESS
6
EVALUATE
ASSESS
1
PLAN
Objectives, Strategies,
Audiences, Actions,
Messages, Media
2
MO
NI
5
e
ienc
Aud rch,
a
rese nel
n
Cha sis
y
anal
TO
R
a
nd
ROLL-OUT
Orient press &
local leaders,
Launch coordinated
interventions
AD
4
JU
DEVELOP
MATERIALS
ST
PRETEST
& ADJUST
Media/IPC,
Training programs,
Community activities
3
NOTE: This figure is an adaptation of several commonly-used planning graphics representing similar iterative approaches created by the NIH
and CDC (communication planning model), the FHI 360/USAID C-Change project (C-Planning), JHU/CCP (P Process), UNICEF (ACADA model) and
others. See also resources in the Annex of this document.
The program process is described as “iterative”
because adjustments are made throughout the
program. A “summative evaluation” measuring
behavioral outcomes against baseline indicators
also serves as the basis for revising strategies and
launching a subsequent program stage. (See figure.)
Principle 2: Effective Communication
is Theory-based
Effective communication programs are based on
explicit theories of how change will occur. In other
words, they propose some logical process of cause
and effect. This process does not have to be a
complicated one. But many communication activities
amount to pure advertising or promotion without any
examination of why an audience is not yet performing
certain “ideal behaviors” and what might influence
them to change.
There are many common theories of social and
behavior change. All involve research to look at the
determinants of behavior—or factors that either
constrain or facilitate change. Some of these may be
“internal factors” (such as beliefs, attitudes, skills,
or a sense that one is able to change—i.e., “self
efficacy”). Some may be “external” to the individual
(such as distance to services, need for approval by a
mother- in-law or husband, quality of care, trust in
providers, or relevant policies).
Background – Rationale for and Purpose of this Framework
PAGE 11
. DEVELOPING A THEORYBASED STRATEGY
An effective communication strategy is
based on a proposed theory or “logic model”
of how targeted changes in individual
behavior will be achieved. In particular,
messages are designed to “move” audiences
from an existing state of awareness, belief, or
motivation to a state more likely to result in
the program’s desired actions.
Effective communication requires good relations between the health
system and the community (Senegal).
Analyzing these determinants helps planners focus
on a few key factors that they decide are central to
people’s willingness or ability to change. (Middlestadt
et al. 2003)
Principle 3: Effective Communication
is System-based
Effective communication programs are based on
analysis of the context in which change takes place.
This means first the health system. Family decisions
about prevention and treatment are potentially
affected by actions of community volunteers, public
and private providers, aspects of the health system
structure itself, and health policies. Efforts usually
need to be targeted at several levels.
Effective programs also look at the need for improving
relationships across different levels of the system.
Lack of trust in health providers, a breakdown in
referral systems, a disconnect between the public
health system and traditional healers or unlicensed
drug dealers who are valued by communities, are
typical barriers.
Change may also require looking at economic and
social systems (resource and time constraints, family
decision making, gender norms, religious beliefs),
legislative issues (such as taxes and tariffs on antimalarial commodities), and influences across sectors
(especially education and agriculture).
From 2007–2012, the PMI-funded COMMIT
project in Tanzania aimed to improve both
prevention and treatment practices using a
multi-level strategy of community outreach
activities conducted by community change
agents, mid-media campaigns (road shows
and mobile video units), and mass media.
Messages focused on the dangers of malaria
and specific actions that could be taken to
prevent and treat it. They aimed to increase
individuals’ self-efficacy to take preventive
actions such as consistently sleeping under a
LLIN, or getting to a clinic when recognizing
symptoms, etc. Using a multi-level strategy
helped to ensure that the messages reached
the intended audiences in a number of ways.
Initial results from an evaluation in 2009
showed that individuals who recalled
messages on malaria from road shows and
mobile video units were more likely to have
higher levels of “perceived threat” from
malaria as well as higher levels of “selfefficacy” regarding their ability to prevent
this threat, and that these individuals were
also more likely to have all their children
under five sleeping under a net.
A 2010 Omnibus survey (n=2000) indicated
that 72% of respondents heard a malaria
message on the radio. When asked if they
took any actions due to the messages, 44%
reported making sure his/her family sleeps
under an LLIN every night.
Sources: Hannah Koenker, personal communication,
April 2012; Tanzania Omnibus Survey, October 2010.
The Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE 12
Effective communication programs look at whole
systems because causes are interrelated and must
be viewed in a holistic manner for change to be
sustained over time.
Principle 4: Effective Communication
Utilizes Appropriate Approaches
In effective communication programs, decisions
about audiences and behaviors influence the types of
communication approaches that will be appropriate.
Multiple approaches are usually necessary to reach
different audiences and create change at several
levels in order to achieve a specific outcome. Among
the most common approaches used to reach public
health objectives are the following:
• Advocacy activities make the case for specific
causes. Causes may include changes in malariarelated policies (requiring actions by high level
officials or groups), improvements in funding,
or increased priority and political will to launch
new programs or support them within given
communities. Audiences may range from national
officials to professional societies, religious
organizations, and local leaders. Common tactics
include engaging the media, working directly
through organizational hierarchies to create
champions, and strategic one-on-one discussions
with policy makers.
. IMPROVING SYSTEM
OUTREACH & MOBILIZATION
Within the formal health system, ANC is the
standard “platform” for delivering preventive
malaria services and products to pregnant
women. At the same time, in every country
there are women who do not attend ANC
because of distance or other barriers.
Senegal has made a concerted effort to
involve communities in malaria prevention
and control, and community health workers
(CHWs) are playing a strong role in
communication and behavior change. A
consortium of NGOs helps bring a basic
package of services to rural populations
in 65 health districts via “health huts” run
by volunteers — including a CHW, birth
attendant, and outreach worker. CHWs
conduct group discussions and home visits
to ensure nightly usage of LLINS, promote
ANC and IPTp, and encourage early careseeking for signs of malaria. They also
mobilize the community for monthly or
bi-monthly outreach activities during which
the chief nurse visits and provides ANC
services, including IPTp.
In addition, since 2009, an initiative involving
the “neighborhood godmother” (or Badjenou
Gokh) has been launched in every village.
The volunteer godmothers receive two days
of training and are equipped with portable
phones, brochures, and flip charts so they
can hold meetings to sensitize village women
and their families about health services
(including malaria prevention and control).
These strategies have all contributed to
improvements from 2005 to 2010 in the
proportion of pregnant women in Senegal
who have benefitted from the protection of
both IPTp and LLINs.
Local leaders review materials on malaria created for Burmese
migrant worker communities in the Mekong.
Source: Sethi et al. 2011.
Strategic Framework for Advancing the Contribution and Quality of Communication
PAGE 13
• Behavior change communication activities are
aimed at bringing about changes in knowledge,
attitudes, and practices among specific audiences
as well as changes in social norms. Goals may
include changes in prescription practices of
private providers, compliance with treatment
regimens by caregivers of children with fever,
or husbands’ support for women to get the
second dose of IPTp. Tactics may involve multiple
communication channels and tools.
• Community and social mobilization engage
networks of people and aim to raise awareness
of a problem and the need for local solutions.
They can also raise awareness of a program,
product, or service; create wider discussion and
participation in an action plan or program; and
promote collective action. Mobilization strategies
(such as community dialogues, high visibility
activities and celebrations) can engage members
to participate in specific activities (such as LLIN
distribution campaigns or household IRS visits)
Rooftop sign at a private health clinic in Uganda promotes ITN use.
and also generate more lasting support for
programs. Community mobilization approaches
gain power through “horizontal” communication
among those who share connections and can also
increase a sense of group efficacy.
• Social Marketing is often associated with the
promotion of a subsidized and branded health
product—such as an LLIN that may be acquired
at an antenatal clinic. However, social marketing
also provides a useful framework for looking
at the concept of exchange from a consumer’s
perspective. The “marketing mix” is often referred
to as the “four P’s” of product, price, place, and
promotion. All of these factors must be acceptable
to a consumer before she/he will “purchase”
a product—or alternately, adopt a new health
practice. Social marketing also emphasizes the
importance of positioning a product or service
in line with consumers’ own values so that they
will choose it over some competing products or
behaviors.
The Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE 14
Strategic Framework for Advancing the Contribution and Quality of Communication
PAGE 15
Strategic Framework for Advancing
the Contribution and Quality of
Communication
This section describes several complementary
processes that will contribute to the improved status
of effective communication within malaria control
programs; ensure that communication becomes an
integral element of prevention and treatment efforts;
increase the overall effectiveness of communication
programs; and contribute to the building of an
essential evidence base and sharing of best practices.
These complementary processes are the following:
• Ensure political commitment
• Improve capacity and coordination at the
country level
• Build a community of practice in communication
for malaria
• Incorporate systematic communication in country
malaria programs
• Improve the evidence base through an operational
research agenda
• Establish an RBM Communication Working Group
Ensure Political Commitment
for Communication
Strong advocacy is needed at the country level
to ensure malaria control programs include
systematic communication. As always, ownership and
sustainability are critical. Communication programs
should be country-led and ensure harmonization of
strategies and messages across donor and partner
efforts.
The RBM Partnership will encourage donors and
organizations working in country programs to provide
funding, capacity building, training, and/or technical
assistance for communication programs. A standard
formula for calculating the funding needed for
communication (e.g., cost per household, standard
formative and summative research activities) is
required so that future budgets can be properly
The African Leaders Malaria Alliance (ALMA) sign an agreement to work with a program funded by the Bill and Melinda Gates Foundation
to reduce taxes and tariffs on anti-malarial commodities. (L to R): George Ingram—President and CEO of AED, acquired by FHI 360;
Ambassador Ombeni Sefue—Tanzania’s representative to the UN; Raymond Chambers—UN special envoy for malaria;
Joy Phumaphi—ALMA’s Executive Secretary.
The Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE 16
estimated. The RBM Partnership will also encourage
malaria-endemic countries to increase attention
and resources to malaria communication programs
(Global Malaria Action Plan).
Improve Capacity and
Coordination at Country level
Challenges
Most high-burden countries now have well-established
plans for malaria control and/or are working to improve their plans. Rarely are these complemented by
technically sound and fully documented communication strategies. Communication working groups to
coordinate strategy development are also rare. Within
countries there is currently high demand for technical
assistance to carry out planning processes, write proposals for communication research, conduct training,
develop appropriate communication materials, and
design M&E systems. Communication activities in
support of malaria prevention and treatment generally
fall to Ministry of Health (MOH) communication or
health promotion units that are understaffed and
overburdened with responsibilities for a wide range
of public health priorities.
Resources are needed to recruit more dedicated
and appropriately trained communication personnel
into NMCPs and allied programs. Staff must be
qualified to plan, lead, implement, and evaluate
complex, large-scale communication interventions
that are effectively integrated within the overall
health system.
Management of Communication
Programs
--
and implementation of communication
interventions
skills necessary to organize a communication
working group of diverse partners for the
purpose of coordinating action and leveraging
resources
• All endemic countries establish a standing
National Communication Working Group to
coordinate communication efforts, develop
national communication strategies, and
leverage resources
• All endemic countries carry out a communication
needs assessment as the basis for developing
a national five-year communication strategy in
partnership with other stakeholders
• All endemic countries produce annual
communication work plans supported by
appropriate and adequately protected budget
allocations
• All endemic countries monitor and document
results of communication programs
Technical Assistance for
Improved Capacity
Communication capacity building is not a one-time
event or a short-term process. Lack of capacity
and funding is a function of the low status of
communication within most ministries of health—
which reduces impact across a range of interventions.
Well-funded donor programs are often guilty of
creating vertical communication programs that
cannot be sustained over time, fail to improve basic
health system structures, and undermine rather
than promote the development of more integrated
communication efforts and capacities.
Recommendations for improving management of
malaria communication activities include:
• All high- and medium-burden countries appoint
a national malaria communication coordinator
possessing:
-- strong understanding of communication theory
and practice
-- solid management skills relevant to scaling up
communication interventions
-- capability to engage and train subordinate
staff and to contribute to the design
Malaria communication programs must have a strong link with
antenatal services. (Tanzania)
Strategic Framework for Advancing the Contribution and Quality of Communication
PAGE 17
. ASSESSING SYSTEMS AND STRUCTURES
In 2005, the Ghana Health Service (GHS)
requested an external assessment of its
systems and structures for conducting health
communication, advocacy, and public relations.
After a plethora of donor-funded communication
campaigns and short-term capacity building
efforts, the GHS was interested in a longer-term
view of how quality communication could be
more effectively institutionalized. The assessment
made recommendations in several areas:
Improve coordination mechanisms: Provide training for high-level health program managers (not
only those in the Health Promotion Unit, or HPU);
establish a high-level body for health communication to promote new policies and procedures;
ensure participation of multi-sectoral partners.
Improve planning mechanisms: Introduce
guidelines to improve joint planning of communication activities; require annual workplans;
revise mandate of the HPU to emphasize management and coordination functions and deemphasize non-results oriented media activities.
Strategies to improve malaria communication
should focus on country ownership and sustainability,
and use the current high profile of malaria to raise
attention to the need for appropriate competencies,
positions, and procedures within the Ministry of
Health (MOH) at the national, regional, and district
levels. This process is best understood as one of
institutionalizing communication within the systems
and structures of the MOH—including those of
greatest importance to decentralization.
Experience in health communication suggests
that capacity-building efforts are more likely to be
effective when one or more of the following elements
are included as part of a long-term technical
assistance package:
• Mentoring: one-on-one relationships between
•
communication specialists and in-country malaria
communication staff
Training: well-organized opportunities
for participants to acquire the necessary
Strengthen coordination of activities with
the regions and districts: Establish a regional
working group and mechanisms to ensure greater
sharing between Center and the regions and
regions and the districts; provide simple tools to
guide effective but streamlined communication
programs; increase material support and
technical assistance to the regions.
Ensure greater ownership of relevant budgets
by the HPU: Provide guidelines on minimum
budgets for communication strategies; require
sign-off on communication budgets in the early
planning stages.
Increase/support staff: Appoint additional
staff including a regional coordinator to
improve links with the regions and districts;
advocate for appropriate promotions and create
appropriate incentives; over the long-term,
provide for a professionally trained health
promoter in each district.
Sources: Seidel and Kelly 2005.
•
•
understanding and skills on a regular or
repeating basis
Networking: connecting in-country malaria staff
to professional networks and working groups
Consulting and support: provision of technical
assistance from a distance, including transfer of
knowledge, provision of feedback and advice, and
assistance in accessing information that might
otherwise be difficult to obtain
Distance learning and self-paced, web-based
communication programs are also useful. Those
already available include USAID’s Global Learning
short courses 514and the USAID/C-Change project
online C-Modules hosted by Ohio University. 6 25
Some countries have approached the longer-term
goal of building national capacity in public health
communication by establishing country-level or
5
6
Available at: http://www.globalhealthlearning.org/login.cfm
Available at: http://www.ouwb.ohiou.edu/c-change/
The Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE 18
regional-level centers specializing in communication
outside of the MOH. With donor funding, Johns
Hopkins University has created such centers in
Nigeria, Uganda, and Zambia. The USAID-funded
C-Change project has also supported development
of a center for excellence at the University of
Witwatersrand in South Africa. Other strategies
have focused on creating distributed capacity by
strengthening networks of local organizations and
improving the capacity of ministry staff to manage
contracts and coordinate the contributions of
experienced NGOs and private sector firms.
(The Annex includes a number of helpful capacity
building references.)
routes—is a high priority in order to build an evidence
base. At the same time, discussion of what has been
tried under less than controlled conditions—or even
what has been tried, measured, and has failed—can
also be extremely valuable to practitioners.
Provide Support at the Global
and Regional Levels
A community of practice would allow for better partner
coordination and help avoid wasteful duplication of
certain efforts. A major focus of such a community of
practice should be the development of an operational
research agenda and broad discussion of results. (This
is discussed further under the section on a Global
Communication Research Agenda.)
Increased coordination at the global and regional
levels is essential for raising the overall status of
communication within malaria control programming
at the country level as well as supporting the quality
of plans and activities. Communication expertise
should be included in RBM technical working groups,
country monitoring missions, and other technical fora
where communication professionals can contribute to
the strengthening of technical capacity.
Build a Community of Practice in
Malaria Communication
The relatively early state of global learning
about malaria communication makes sharing of
experience particularly urgent. A critical strategy
for strengthening national and subnational
communication capacity is the documenting and
discussion, both within and across countries, of both
formative and summative research results. Large
international technical organizations generally have
processes for capturing and disseminating such
information. However, a wealth of knowledge is
generated within affected countries and much of this
is not shared beyond immediate borders or among a
handful of practitioners.
The documenting and publishing of best practices—
approaches that have resulted in significant
measurable changes in targeted behaviors within
specific contexts and through explicitly articulated
The purpose of a community of practice is to bring
together those with a common interest in the voluntary
and open sharing of knowledge. The opportunity
for self-selection into such a group and so-called
horizontal communication mechanisms are especially
congenial to this kind of sharing. Casting the net wide
and encouraging participation by country practitioners
in particular (and employing channels appropriate for
them) is a priority.
In addition, formal dissemination processes and tools
are crucial to make knowledge and expertise available
to NMCPs and other country-level malaria efforts.
These must allow the easy access and sharing on
a regular basis of guidelines and best practices on
communication for malaria control.
Illustrative channels for sharing include face-to-face
meetings, virtual meetings (webinars and video conferences), electronic dissemination (listservs and blogs),
and establishment of repositories/databases. Various
electronic knowledge exchange mechanisms on malaria
and other health communication areas are already functioning. These include the Communication Initiative 73,6
the PMI Special Collection Repository 84,7 UNICEF 95,8 Health
Communication Exchange, C-HUB1069and HDNet.
A first step in building a community of practice should
be an assessment of knowledge sharing processes
that currently exist. This should be followed by
recommendations for additional support to promote
channels and activities that are already functioning and
valuable, as well as consideration of new opportunities.
www.comminit.com,
http://www.c-hubonline.org/collections/pmi.html,
9
www.unicef.org,
10
http://www.c-hubonline.org/
7
8
Strategic Framework for Advancing the Contribution and Quality of Communication
PAGE 19
Incorporate Systematic
Communication in Country
Malaria Programs
Effective malaria communication programs are
designed based on principles already described in
the section on Terms and Concepts. In addition,
interventions should be designed according to a
systematic process that includes a number of core
elements. These are described below. While this
process is basically an iterative one, the first four
elements described below are highly synergistic and
may overlap or take place in an order different from
what is laid out here.
(This section is not meant to provide detailed
guidelines on how to plan and carry out a
communication program. The Annex suggests a
number of resources created for this purpose.)
Leveraging Partners, Existing
Resources/Strengths
Building relationships with partners, allies,
stakeholders, and gatekeepers is critical to
all components of a malaria communication
intervention. This process should be the first
step and should continue throughout the
program, mobilizing many levels of society. The
team should include staff from relevant MOH
units (communication, NMCP, child health and
reproductive health), donors and representatives
from ongoing programs and involved NGOs, and
representatives from the national media and the
private sector. Working with partners will ensure
needed ownership of the program, harmonization
of messages conveyed by different groups, and
coordination during implementation; will assist in
leveraging resources; and will further advocacy
goals of the overall malaria program. Working with
other health units beginning in the planning stage is
especially important in order to integrate strategies
into the basic structures of the health system rather
than create stand-alone campaigns.
. THE PLANNING/
PARTNERING BOND
In Tanzania the COMMIT project worked
in partnership with the National Malaria
Control Program and multiple stakeholders to
develop the National Malaria Communication
Strategy that accompanied the Malaria Mid
Term Strategy for 2008-2013. The Strategy has
served as an effective guide for disseminating
harmonized messages by a number of malaria
partners and other ministry departments.
The process of writing the plan was itself a
partnership-building exercise that fostered
respect and opened lines of communication
among the partners.
In Western and Nyanza Provinces of
Kenya, USAID’s C-Change project
provided technical support to three nongovernmental organizations (Merlin,
PATH, and World Vision) to assist them
in planning community-level activities
aligned with the Kenyan National ACSM
Malaria Strategy. The team collaborated in
organizing complementary approaches at
the community in adjacent geographical
areas and coordinated at the field level.
An independent evaluation in 2010 indicated
that the NGO interventions led to an average
increase of 25-35% in three target behaviors
(appropriate use of LLINs, IPTp services
and treatment-seeking for children) in the
intervention areas.
School children review information with their teacher about malaria
prevention in Tanzania.
Sources: Robert Ainslie, personal communication,
April 2012; G.A. Pirio, 2010; Thaddeus Pennas, personal
communication, April 2012
The Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE 20
Situational Assessment—Health
Problem, Policies, Target Groups,
Research
A situational assessment describes the overall
context of the communication program. It states
the health problem/s in behavioral terms (e.g.,
current usage by vulnerable target groups). It
outlines relevant policies and potential areas for
discussion (e.g., role of CHWs in distributing antimalarials, products available in the private sector
and commodity regulations). It identifies major
partners and current malaria communication and
social mobilization programs already underway
in the country. A major purpose of the situational
assessment is to map out existing research on
target audiences and common barriers to desired
prevention and treatment behaviors. The assessment
should propose additional formative/developmental
research to fill important gaps in existing studies
and outline a timeline and roles for managing this
research. It should also identify potential sources of
baseline knowledge, attitudes, and practice (KAP)
data and propose additional quantitative surveys if
necessary so that progress can be measured. Partner
contributions will be crucial to this assessment; joint
analysis of the information will help launch a team
approach to problem consideration and coordination.
National Communication Strategy
The national communication strategy document
provides a broad framework for activities. Annual
workplans provide details and budgets for rolling
these out. The national strategy document serves as
a reference to ensure activities are objective-driven,
messages are consistent and harmonized across
partners, approaches target priority audiences
and aim to influence key factors (or determinants)
identified by research.
The strategy should outline approaches for affecting
multiple levels of the system: caregivers/clients
and communities, health providers, institutions, and
policy makers. It should include all of the elements
described in the sub-heads below. In addition,
it should include a plan for documenting and
disseminating best practices following summative
evaluations. It may also recommend specific actions
for strengthening health communication capacity
(e.g., at the national or district level) within the larger
health system.
. FORMATIVE RESEARCH FOR
A NEW INTERVENTION
In Uganda, formative research was conducted
in 2008 in Iganga district to help anticipate
challenges connected with introducing RDTs
by community medicine distributors (CMDs).
The study included focus group discussions
with CMDs and both mothers and fathers
of young children, and key informant interviews with health workers and community
leaders. Four key findings emerged:
• CMDs are trusted by their communities
because of their commitment to
voluntarism, accessibility, and the
perceived effectiveness of the anti-malarial
drugs offered
• Community members, health workers,
and CMDs welcomed the use of RDTs
by CMDs provided they have sufficient
education, are trained in their use, and are
supported to follow up with children
• Fears were expressed that CMDs who
collect blood using RDTs could expose
children to HIV, that the tests could be
used to test children for HIV, or that the
blood could be used for witchcraft
• CMDs were anticipated to face challenges
with transport for follow up of patients and
restocking supplies, adults demanding to
be tested, and caregivers insisting their
children be treated instead of referred
The study provided information for
designing a communication strategy to
address community fears and stigma about
drawing blood, as well as to plan training for
the CMDs.
Source: Mukanga et al. 2010.
The process of creating the plan, like the situational
assessment process, should help cement relations
among partners. As audiences and strategies for
reaching them are discussed, the importance of
additional partners may also become clear (e.g.,
those in other sectors such as education).
Strategic Framework for Advancing the Contribution and Quality of Communication
PAGE 21
Communication Objectives
and Key Actions
Audience Segmentation and
Approaches for Reaching Them
During the assessment, prevention and treatment
targets are analyzed and prioritized according to
prevalence, geographic and demographic factors, and
in the context of health service delivery structures.
The national strategy sets measureable program
objectives for progress in priority interventions.
Targets must be Specific, Measurable, Attainable,
Relevant, and Time-bound. They may focus on
utilization rates as well as desired policy changes.
For example:
Audience segmentation goes hand-in-hand with
the setting of objectives. Malaria control programs
focus on populations most at risk, including those
in specific regional, socioeconomic, and biological
groups (such as pregnant women). In addition, the
communication strategy identifies the primary target
audiences (those who will perform the key health
practices) and secondary audiences (those who
influence the primary audiences). Secondary
By 2017, appropriate use of LLINs by all pregnant
women in rural areas will increase from X to Y%
. THE PRESCRIBER-CLIENT
By 2017, the proportion of women attending any ANC who
receive two doses of ITPp will increase from X TO Y%
An estimated 40 to 50% of all anti-malarial
drugs are distributed through the informal
private sector. In recent years several countries
have focused on improving prescription and
counseling practices of private providers.
By 2017, the Ministry of Trade will remove taxes
and tariffs on imported LLINs
Each objective is then broken down into a list of
communication objectives linked to actions by
specific audiences. These actions describe the
pathway through which the targets will be achieved
and highlight needs/gaps in current behaviors (rather
than actions the vast majority of people are already
taking). Key actions are always specific to a given
context and culture. For example, to improve IPTp
utilization, a program may have to address actions
by husbands in support of wives attending multiple
ANC visits and actions by providers to prioritize SP
doses for pregnant women. Formative research
uncovers which changes in the current status quo are
necessary to make a difference. (The box on the next
two pages outlines illustrative actions and audiences
for different objectives, or “ideal behaviors.”)
Many people consult with private providers and shop keepers about
how to prevent and treat malaria. (Uganda)
RELATIONSHIP
A program in Kilifi District, Kenya, in
collaboration with the Kenya Medical
Research Institute-Wellcome Trust Research
Programme, used multiple strategies to change
the behaviors of providers and also increase
community support for their advice.
Community participation was solicited in
identifying highly-trafficked, stable, and
popular retail shops. Shopkeepers received
four days of training focusing on appropriate
prescribing practices (including introduction
of SP as the new first-line treatment at the time)
and counseling. They received certificates and
logos to identify their shops as “trained outlets.”
Public information activities aimed to identify
the trained retailers, promote early treatment of
childhood fever, and explain the change in drug
policy. Channels included women’s groups,
parent teacher associations, and celebrations
with local dance and drama groups.
Pre and post surveys with mystery clients
showed that overall the proportion of shoptreated childhood fevers receiving an adequate
dose of a recommended anti-malaria drug
within 24 hours rose from 1 to 28% between
1999 and 2001.
Sources: Marsh et al., 2004; Foster 1991; RBM 2011.
Global Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE 22
Illustrative Audiences (Actors), Actions, and
Their Constituent “Parts”
Appropriate Use of ITNS/LLINS by Pregnant Women, Children Under Five, and Others
Actors: Policy makers
• Ensure removal of taxes and tariffs
• Support a coordinated LLIN strategy
• Support universal coverage
• Support appropriate environmental
protections (e.g., disposal of LLINs)
Actors: Family decision makers
(heads of households, mothers-in-law)
and vulnerable groups
• Acquire LLINs (attend distribution venue,
acquire and use voucher if appropriate)
• Hang LLINs correctly and at sundown
• Vulnerable groups have priority for use
(pregnant women, children under five)
• Sleep under LLINs every night
• Take proper care of LLINs
Actors: Health service providers and
community volunteers, distributors (vendors)
• Promote LLINs at every opportunity (ANC
visits, child visits, etc.)
• Counsel on how/when/who should use LLIN
• Distribute and explain vouchers as needed
and provide information on where to get LLINs
Actors: Community leaders, organizations
• Promote LLIN use to prevent malaria
(community meetings, child health days, etc.)
• Promote hanging of nets at sundown
every night
• Promote and support volunteerism
Actors: Local media
• Promote LLIN use to prevent malaria;
promote hanging of nets at sundown and for
every night
IRS: Delivered to Homes in Designated Areas Prior to Rainy Season
Actors: Policy makers
• Explain the rationale and implications of IRS
• Include IRS as a malaria prevention strategy
for the NMCP as appropriate
Actors: Health System
• Alert communities to planned visits by
sprayers and provide information about how
to prepare
• Respond to concerns, provide feedback to
health system
Actors: Local media
• Provide advance information about visits
by spray persons so community can be
alerted/prepared
• Provide accurate information about IRS
Actors: Community leaders, organizations
• Link with health system to clarify and
correct rumors
• Facilitate planning with health system, link
with community (e.g., via group discussions)
• Alert communities about scheduled spraying
Adapted from PMI Communication and Social Mobilization Guidelines http://www.pmi.gov/resources/publications/
communication_social_mobilization_guidelines.pdf (accessed June 6, 2012) and Seidel, R. Behavior Change Perspectives
and Communication Guidelines on Six Child Survival Interventions (AED/JHU-CCP/UNICEF) 2005.
Strategic Framework for Advancing the Contribution and Quality of Communication
PAGE 23
IPTp: At Least Two Doses Received by All Pregnant Women Beginning After Quickening
Actors: Policy makers
• Appreciate and be able to explain the
dangers of malaria during pregnancy
Actors: Health service providers and
community health workers/volunteers
• Enforce the national IPTp policy
• Provide correct SP dose to healthy pregnant
women at correct times
Actors: Pregnant women
• Do not give SP to other clients (according to
national policy)
• Attend ANC early and at least twice
according to national policy
• Explain purpose of SP and potential
side-effects
• Demand and accept a minimum of two doses
of IPTp following quickening
• Encourage early and frequent ANC
attendance; give appointments for next visits
Actors: Family decision makers (heads of
households, mothers-in-law)
Actors: Community leaders, organizations
• Encourage early and frequent ANC visits
• Support women in attending ANC early and
at least twice according to national policy
• Support IPTp for pregnant women to protect
mother and baby
• Support women in receiving a minimum of
two doses of IPTp
Actors: Local media
• Promote early ANC and a minimum of two
doses of IPTp to protect mother and baby
Appropriate Care-seeking for Malaria and Compliance with RDTs and Drug Therapy
Actors: Policy makers
• Endorse classification of first line ACT for
over-the-counter sale and distribution
• Support introduction/expansion of RDTs
• Support the establishment of a quality
control system for anti-malarials
• Support home management of malaria and
outreach/provision of drugs by appropriate
CHWs
• Support integrated management of childhood
illness at the community level
Actors: Caregivers and family decision
makers (heads of households, mothersin-law)
• Recognize signs and symptoms of malaria
• Seek treatment for children within 24 hours
of on-set of fever
• Accept use of RDTs by health provider
• Acquire and give the right ACT, in the right
dose, for the right number of days
• Recognize signs of severity/failure to respond
to treatment; seek help from legitimate
provider promptly
Actors: Health service providers and
community health workers
• Ask about previous treatments (to identify
treatment failures) and symptom history
• Prescribe the right ACT in the right doses
• Explain clearly how to take the medication
and discuss side effects
• Recognize signs of severe disease and treat
or refer, according to national policy
• Do not give SP to other clients (according to
national policy)
• Explain purpose of SP and potential
side-effects
• Encourage early and frequent ANC
attendance; give appointments for next visits
Actors: Private medicine dispensers
(same as for health service providers, above)
Actors: Local media
• Promote use of RDTs and ACTs to treat
malaria effectively and avoid drug resistance
The Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE 24
audiences may be a central focus of communication
because they are actual decision makers. Tertiary
audiences (community groups, local leaders, those in
other sectors) are also addressed if their support is
critical to efforts.
Formative research provides important information
for segmenting audiences. For example, user/nonuser (or “doer/non-doer” analysis) may reveal that
people with certain beliefs or values, belonging to
certain cultural or religious groups, or having certain
support systems are more or less inclined to carry
out a desired behavior. First-time mothers may
behave differently with respect to an intervention
than those with several children, and so forth.
Analyzing the propensity of different audience
segments to carry out priority behaviors and
identifying the key factors that hinder or motivate
them to take action provides the basis for designing
approaches that have the best chances for producing
measurable change.
Intervention Approaches/Channels,
Messages, and Materials
The national communication strategy should
clearly describe audience segments and social and
behavioral determinants (or key factors) identified
through the formative research and link these
directly to proposed communication approaches
designed to address them. This transformation of
research results into creative strategies is the reason
communication programs are said to require both
science and art.
. MOBILIZING SPECIAL
POPULATIONS
Pastoral communities in Africa have deeprooted traditional leadership systems. Successful communication programs must engage this
leadership to mobilize local populations.
In Ethiopia, community-based malaria control
was adopted in the 1990s to improve access
to early diagnosis and treatment. Community
health workers (CHWs) provide first-line antimalarials and refer serious cases to the health
facility. Since 2005, AMREF has supported
a program in the Afar region, which is 90%
pastoralists, in order to strengthen links
between communities and the health system
and improve both access to malaria products
and services and household practices.
In addition to training CHWs, equipping
health centers, and distributing ITNs, the
program trained mother coordinators in each
village to visit households and both educate
and motivate families. AMREF developed
and tested a simple, largely pictorial toolkit to
support their interactions. Local leaders also
received training and were involved in recruiting the mother coordinators and facilitating the
door-to-door distribution of ITNs.
As a result of the combined strategies, from
2005 to 2007 the proportion of pregnant women
and children under five who slept under an
ITN the previous night increased from 27 to
86.5% and from 17 to 84% respectively. Treatment seeking behaviors for fever also increased. However, only 14.3% of under-five children with fever were treated within 24 hours,
reflecting both access and cultural barriers.
Sources: Nigatu, et al. 2009.
Producer Boubacar Sidibe films actors for a TV sketch about malaria
in Bamako, Mali.
Strategic Framework for Advancing the Contribution and Quality of Communication
PAGE 25
Communication research should also be used to
identify communication channels which provide the
right combination of reach and frequency of message
delivery. Different channels have different strengths,
challenges, and costs, and an effective strategy uses
a mix of channels that are mutually reinforcing. The
strategy should also describe the key messages
for different audiences and actions, as well as the
materials to be designed and delivered.
Implementation Rollout
Concept Testing/Pre-Testing
The communication strategy should provide a
framework that links all elements in a phased and
coordinated way. This framework should also be
explicitly integrated with supply and service elements
and with relevant aspects of the health system
structure itself. “Balancing supply and demand” is
one of the basic principles of effective communication
programs. Creation of demand for services that are
inadequate or lacking undermines the health system
and the credibility of future communication efforts.
Intervention elements should be developed and
tested directly with the audience. Concepts,
messages, radio scripts, prototype communication
materials, are pre-tested via standard research
methods. Pre-testing helps confirm whether
storylines, messages, and materials are understood,
acceptable, and have the desired effect with the
intended audience segment. Information is used
to make adjustments. Small-scale tests of training
strategies or other face-to-face interactions (e.g.,
with health workers, CHWs, pharmacists, or informal
drug providers) should also be incorporated into
planning before large-scale rollouts.
Press conference with the Cameroon Ministry of Health, as part of
the K.O. Palu NightWatch campaign.
. COORDINATING CHANNELS — “NIGHTWATCH”
The nonprofit organizations Malaria No More
and Lalela Project have designed coordinated
campaigns called “NightWatch” to remind people
to sleep under their mosquito nets. The primary
message is a simple but powerful behavioral
trigger: “It’s 9 p.m. Are you and your family safe
under your mosquito nets tonight?”
Campaigns were launched in Senegal (2010),
Cameroon (2011), Chad (2012), and Tanzania (2012).
Multiple media and cross-sector activities included:
• High quality public service announcements
featuring international and local celebrities
(Alexandre Song—footballer, Youssou NDour—
musician, Luc Mbah a Moute—NBA, 50 Cent,
etc.) These are aired on national and regional TV
and radio stations at 9 p.m. (around the time the
malaria-carrying mosquitoes come out)
• Nightly SMS messages sent by TIGO Senegal,
Airtel Chad, and MTN Cameroon to both rural
and urban mobile subscribers
• Complementary school curriculum on malaria
prevention reaching students aged 12-14
• Nationally broadcast press event and concerts,
which in turn receive broad media coverage
In Senegal, an evaluation (2011) showed children
whose parents heard the campaign messages were
8% more likely to have slept under a life-saving bed
net the night before. In Cameroon, an evaluation
(2012) showed that the campaign had a statistically
significant impact on net use by both adults and
children, even when controlling for net ownership,
level of education, urban/rural location, gender,
and media use.
Sources: Malaria No More website: (http://malarianomore.org/
what-we-do/nightwatch) and Senegal Impact Report, Malaria
No More, 2011.
The Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE 26
Popular Senegalese artist Youssou NDour arrives for the launch of the Xeex Sibbiru (Fight Malaria) concert and campaign launch.
Other elements of planned implementation rollout
include strategies to manage potential problems
(e.g., delays of an already-announced delivery of
free LLINs). Adequate community preparation for
campaign launches (e.g., engaging local leaders
and local media contacts) and including media
partners in the national communication working
group help reduce the likelihood of rumors or
negative publicity and can mitigate the fallout if
something unforeseen does happen.
Careful timing of different elements during the
rollout, as well as quick response systems to adjust
strategies if necessary, are crucial during this phase.
The implementation rollout strategy should
identify partners at different levels and an overall
coordinating structure at the national, provincial, and
district levels so that roles are clear.
Monitoring and Evaluation (M&E)
The communication strategy should describe the
broad plan for monitoring and evaluating program
processes, inputs, outputs, and outcomes. Since
many activities are likely to be carried out by
partners, the monitoring plan will have to be
designed in a coordinated fashion, led by the NMCP’s
M&E unit. The purpose of monitoring is to make
sure program processes are on track and provide
opportunities to make midcourse corrections.
Communication staff and the M&E unit should work
together to enhance regular reporting systems
if necessary with pertinent data (which may be
quantitative or qualitative in nature). A summative
evaluation should be planned to compare progress
in targeted knowledge, attitudes, and practices (as
well as other objectives such as policy changes) to
baseline measures.
Strategic Framework for Advancing the Contribution and Quality of Communication
PAGE 27
Monitoring of program activities involves tracking
and assessing specific outputs (what activities are
carried out, where, by whom, and when) previously
defined for each activity to determine program
progress and measure the quality of the interventions
and materials. A mechanism for collecting data
and reporting on specific output indicators for each
activity should be developed and carried out on a
regular basis during implementation. (See box below
with sample tracking tool.)
Overall outcome indicators will form the basis for
assessing the interim and long-term impact of the
program (such as changes in knowledge, motivation,
ability to act, social norms, etc.) and should be
evaluated by independent research organizations.
TABLE 1: Illustrative example of M&E tracking tool for LLIN hang-up campaign*
Reporting
Frequency
Responsible
Party
Training records
One time; after
training
Implementing
partner
HH visit forms —
Output: Reach
Proportion of households (HH) in target area visited by team first visit
One time; after
first visit
Implementing
partner
Indicator
Data Source
Process
Number of individuals trained to conduct door-to-door visits
Num: Number of HH in target area visited by team
Denom: Number of HH in target area
Census data for
target area
Output: Service delivered
Proportion of HH visited by team that either had a net
already hanging or a net was hung by team.
Number of nets hung by team at time of visit.
HH visit forms —
first visit
One time; after
first visit
Implementing
partner
HH visit forms —
follow-up visit
One time; after
follow-up visit
Implementing
partner
HH visit forms —
first visit and
follow-up visit
Two times; after
first visit and
follow-up visit
Implementing
partner
HH visit forms
– first visit and
follow-up visit
Two times; after
first visit and
follow-up visit
Implementing
partner
Num: Number of HH in target area visited by team with net
already hanging or a net was hung by team
Denom: Number of HH in target area visited by team
Outcome: Recall/knowledge
Proportion of HH receiving a hang-up visit that can recall
the communication message at follow-up.
Num: Number of HH visited at follow-up where someone in
the HH recalls the communication message
Denom: Number of HH visited at follow-up
[Assumes HH visited at follow-up received an initial visit
where someone heard the communication message]
Outcome: Attitude/intention
Proportion of HH receiving a hang-up visit that report it is
likely everyone in the HH will sleep under an LLIN every
night (and specify children <5)
Num: Number of HH reporting an intention for everyone in
HH to sleep under an LLIN every night
Denom: Number of HH visited – first and follow-up
[Comparison of responses at first visit and follow-up visit]
Outcome: Behavior
Proportion of HH reporting everyone sleeping under an
LLIN the previous night (and specify children <5)
Num: Number of HH reporting that all HH members slept
under an LLIN the previous night]
Denom: Number of HH visited (first visit and follow-up
[Comparison of responses at first visit and follow-up visit]
*Adapted from: President’s Communication Malaria Initiative Communication Team. (2012 draft) The President’s Malaria Initiative Monitoring
and Evaluation Strategy for Behavior Change Communication. PMI.
The Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE 28
Conducting baseline, midline, and endline evaluations
will allow for scientific documentation of outcomes/
changes in the population due to the intervention.
Once data have been collected and analyzed, reports
and survey findings should be shared with key
stakeholders along with recommendations on how to
improve their current program activities.
Budget/Funding
Lastly, the national communication strategy should
include an overall budget for the program. It should
include estimates for the costs of research and
evaluation; development, pre-testing, production, and
distribution of materials; community mobilization;
training and supervising clinical and community
based providers; and coordination/management.
Estimated partner contributions to the budget should
also be included.
Communication budgets for many health areas
are typically underfunded, and these budgets may
be the first to be tapped for unrelated purposes if
unexpected needs arise. The President’s Malaria
Initiative recommends reserving 10–15% of an
OPERATIONAL & BEHAVIORAL
RESEARCH
The GMAP emphasizes the importance of
behavioral research, which is one type of
operational research.
overall malaria program budget for communication
activities. The Global Fund recommends that 10% of
program funds be allocated to communication. Yet
another approach is to calculate a specific percent of
malaria-related commodity costs and allocate that
amount towards communication activities. Costs
will vary according to the nature of research needed,
channels appropriate to the target audiences,
complexity of segmentation and reach issues, and
other contextual factors. Summative evaluations to
analyze the contribution of communication to results,
and to understand what has worked and what has
not, are particularly important but are also costly.
Table 2 on the next page provides a list of illustrative
program functions and budget items managers
should consider when projecting (and protecting)
funds for communication.
Global Communication
Research Agenda
Resources continue to flow into research and development for more effective treatment, protective
LLINs, vaccines, and other biomedical and environmental interventions. However, few resources are
available to conduct operational research to understand the cultural/social, behavioral, communication,
economic, and structural factors that affect use of
such interventions by at-risk populations.
“Operational research (OR) is defined as ‘the
use of systematic research techniques for
program decision-making to achieve a specific outcome. OR provides policy-makers and
managers with evidence that they can use to
improve program operations.’
“Behavioral research will be necessary to help
ensure preparedness for implementation of
strategies, particularly surrounding those of
new interventions and approaches.”
— Global Malaria Action Plan
A woman in Senegal repairing a bed net: an important behavior that
has not yet been well studied.
Strategic Framework for Advancing the Contribution and Quality of Communication
PAGE 29
TABLE 2: Selected Cost Components for Communication*
Program Function
Budget Items
Audience research
(design, data collection, analysis, reporting)
Staff time
Consultants and/or subcontracts
Per diem, lodging, and travel expenses
Fuel, supplies
Strategy design
Staff time
Consultants
Per diem, lodging, and travel expenses
Meeting room rent, supplies
Design and development of print materials
Staff time and consultant time (e.g., for writing, drawing, photography, design and layout, word processing, translation)
Writing and development of broadcast materials
Staff time and consultant time (managerial, creative, and technical
input, translation)
Cost of subcontract to advertising firm
Development of local communication channels
(e.g., drama groups, mobile vans, fairs, miking,
mosque announcements, etc.)
Staff time and consultant time (managerial, creative, and technical
input, translation)
Cost of subcontract and/or of ongoing expenses (per diem,
travel, etc.)
Equipment purchase or rental
Pre-testing and refinement of materials
(design of protocols, data collection, analysis,
reporting; refinement of materials as required)
Staff and consultant time and expenses (per diem, lodging, travel)
and/or subcontract
Supplies (e.g., paper, video equipment, recording)
Production and broadcast
Printing
Audio and video recording and production
Broadcast/air time
Distribution/dissemination of materials and
orientations
(account for all costs down to the recipient)
Staff and consultant time (e.g., for planning, implementing)
Per diem, lodging, travel expenses
Fuel
Production and copying of forms for tracking
Training in communication, social mobilization,
or advocacy
(especially for journalists and champions)
Staff and consultant time (e.g., for planning, implementing, evaluating training)
Travel, per diem and expenses of participants
Rental of venues
Informing and interacting with the national and
local press and with champions
(pre-program launch & response to unforseen
events)
Staff and consultant time (planning, implementing)
Travel and per diem
Preparation and printing of materials
Monitoring
(design, data collection, analysis, reporting)
Staff time
Consultants and/or subcontracts
Per diem, lodging, and travel expenses
Fuel, supplies
Mid-course Program Adjustments
Staff and consultant time for management, redesign
Summative Evaluation
(design, data collection, analysis, reporting)
Staff time
Consultants and/or subcontracts
Per diem, lodging, and travel expenses
Fuel, supplies
Management and Supervision
Staff time
Travel, per diem, lodging, fuel
* Adapted from Immunization Essentials: A Practical Field Guide (USAID) 2003.
The Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE 30
During the series of consultative meetings held
in 2011-2012 to develop this Strategic Framework,
representatives discussed the need for an operational
research agenda to increase the effectiveness of
communication interventions regarding malaria
prevention, diagnosis, and treatment and to expand
the evidence for scaling up.
Some research should be embedded in ongoing
NMCP activities to minimize the disruption and
distortion that often arise from scaling up isolated
research projects.
Expected Contribution of
Operational Research
The key factors in nightly bed net use by families vary across
countries and over time.
Operational research (OR) for communication
should aim to improve the targeting, efficiency,
and effectiveness of programs in countries and
regions (especially remote and rural) where these
interventions are most needed.
Advancing the State of
Communication Research
Knowledge gained from OR should: 1) increase
understanding of complex behavioral determinants
and channel effectiveness in specific contexts;
2) provide a foundation for advancing the use of
an evidence base in program design; and 3) help
demonstrate that rigorous application of evidence
in communication does contribute to improved
prevention and treatment-seeking behaviors among
intended audiences.
Current challenges to bolstering the evidence base
with OR include:
• Weak malaria communication/operational
research capacity with limited reliable results
• Lack of consensus on priority behavioral and
•
impact studies for malaria communication
Scarce funding for malaria communication
research and insufficient interest among
non-communication-oriented partners and
organizations to include communication in
programs and budgets
. DETERMINANTS OF ITN USE
Determinants of ITN use have varied over time
and from country to country.
Research in Ghana in 2008 examined ten
different variables and their association with net
use the previous night. Results indicated that net
use was positively associated with rural location,
lower socioeconomic status (SES), knowing that
mosquitoes transmit malaria, not using coils for
mosquito control, having newer nets or those in
good condition or light blue in color, and having
paid for the net instead of having obtained it free.
The researchers suggested that net use would
increase if colored nets were made available in
mass distributions; if programs emphasized that
malaria is caused only by night-biting mosquitoes
and that nets protect against mosquitoes better
than coils; if donated nets were replaced more
frequently so that households have nets in good
condition; and if there were support for the
commercial market so that those who can afford
to purchase a net and want to choose their own
nets can do so more easily.
Over time, as access to nets improves and
knowledge about malaria increases, factors
related to net use can also be expected to change
and additional studies about barriers will be
needed in these same countries.
Sources: Baume and Koh, 2011
Strategic Framework for Advancing the Contribution and Quality of Communication
PAGE 31
Partners agreed on two overarching priorities
for action:
• Define and implement a set of operational
•
research activities that leads to improved
communication strategies and increased impact of
communication on overall malaria control efforts
Develop, expand, and support technical capacity
(both nationally and internationally) to carry out
high-quality malaria communication research
Strategic Direction and
Priority Topics for Research
Strategic direction and specific topics for a research
agenda fall into three basic categories:
Improved understanding of factors that impede
or encourage the recommended behavior. Casecontrol (also called doer/non-doer) studies are
needed to understand reasons for low performance
of recommended behaviors. This may include nonacquisition of available LLINs; non- or inconsistent
use of LLINs that are in the home; poor treatment
compliance (both over- and under-treatment) of
cases; low IPTp uptake where drugs are available,
especially for the second dose; and refusal to accept
insecticide spray persons in the home (especially
after a first IRS experience). Such research
compares those who behave in accordance with
recommendations with those who don’t. Key factors
beyond access may include sources of knowledge,
different reinforcements for correct behavior, and
other issues. Differences between doers and nondoers should be studied within specific audience
segments (urban and rural populations, central/
marginalized groups) once poorly performing SES or
geographic groups are identified.
As countries achieve universal coverage of
interventions and knowledge in the general
population improves, the relative importance of
behavioral determinants can change. Positive
behaviors may increase but plateau, and emphasis
must shift to decreasing a range of external barriers
beyond access, and motivating consistent and
habitual performance of some behaviors as well as
trial of new ones (e.g., overcoming constraints to
hanging multiple nets in small homes, motivating
willingness to repair or replace nets).
Where problems persist, behavioral studies can help
investigate programmatic solutions (e.g., allowing
women to take home IPT doses when health facilities
have no water or cups).
As part of the Zinduka! Malaria Haikubaliki (Wake up! Malaria is unacceptable!) campaign, Tanzanian school children learned how to prevent malaria (shown here, how to hang an LLIN) and become catalysts for change in their communities.
The Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE 32
Improved understanding of channel effectiveness.
Effective communication programs employ multiple
reinforcing communication channels to reach
audiences with sufficient frequency and impact.
Ad agencies, the DHS, and other standard surveys
already supply information on the reach of different
communication channels to specific populations.
Rapidly expanding access to mobile technologies
requires a nearly constant updating of basic
information about how groups receive and exchange
information. Beyond these basic data, operational
research can examine the type of content conveyed
by different channels: for example, information
vs. emotion/reinforcement. Case studies about
the application of new technologies (such as SMS
and social media) to affect specific malaria control
behaviors will be helpful. The impact of social
networks and social influence are equally important,
if more difficult to study. Once again, case-control
(doer/non-doer) research is likely to provide the most
valuable information for readjusting programs.
Pressure is sometimes put on programs to
disaggregate effects by channel, or to determine
which channel or activity has the power to act as
a “magic bullet” for behavior change. This can
lead to complex evaluation designs, with distinct
populations receiving different “treatments”—
which can be difficult to achieve, since many
communication approaches spill over beyond the
target population. An alternative is to phase in
different elements of the intervention, coupled with
continuous monitoring of the desired outcomes,
ideally using routinely collected data. An uptick in
the desired outcome associated with a specific input
can be read as the added value of that input given
the previous inputs. If this analysis is repeated in
different locations, with the order of inputs varied,
systematic review of the results may show that one
or several inputs can be dropped.
Improved and appropriate research approaches and
tools. Priorities include developing new methods for
providing robust impact analysis, such as propensity
score matching. In addition, improved methods
and better use of existing methods are needed for
investigating behavioral and social determinants.
Illness narratives, direct observations in the home
and health facility, and other approaches require only
small samples but systematic and careful conduct
and analysis. Case studies and rigorously tested tools
should be shared—not only across organizations and
countries among those working on malaria, but also
with people working on other health issues.
Increased emphasis can also be placed on use of
routinely collected data as the basis for evaluation,
with time-series analysis linking effects with inputs.
A first step would be a coordinated review of the type
and quality of data collected by a country’s health
system. Data collection mechanisms in place are
often unreliable (whether HMIS or health records); in
addition, routine data may need to be supplemented
by collection of qualitative information essential to
communication programs.
RBM Communication
Working Group
At the time of this document’s printing, there was
limited structure within the RBM Partnership to
achieve consensus on best practices or to coordinate
partners’ country level communication support. In
addition, communication was not mainstreamed into
the work of the other RBM Working Groups.
The consultative meetings held in 2011-2012 (and
building on the work of others) recommended
SUPPORT FOR THE CONCEPT OF A
COMMUNICATION WORKING GROUP
In 2008, the GMAP reflected on the need
for a task team or working group focused on
communication:
“Currently there is no structure within the
RBM Partnership that coordinates partners’
country level communication support..Following a RBM Board decision in 2007, the
Malaria Advocacy Working Group (MAWG)
was tasked with seeing where a revitalized
focus on country level communication activities could be situated (for example, as a task
team or new working group.)”
— Global Malaria Action Plan
Strategic Framework for Advancing the Contribution and Quality of Communication
PAGE 33
formalization of an RBM Communication Working
Group with the overall goal of ensuring that effective
malaria communication strategies are implemented
at scale in malaria-endemic countries in Africa.
The working group will help coordinate partners
and serve as a focal point for implementation of the
present Strategic Framework. Activities will focus on
guiding, developing, and documenting best practices
and increasing capacity in malaria communication in
malaria-endemic countries in Africa.
A specific proposal drafted in 2012 to form such
a working group recommended that the key
responsibilities of such a group will be to:
• Facilitate the provision of technical assistance to
countries and partners as needed to improve the
quality and capacity to implement results-driven
malaria communication programs
• Prioritize and direct the research agenda as
detailed in the Strategic Framework
• Promote and encourage active sharing of
experiences in order to advance the state of the
art in communication for malaria control and
prevention, and to promote the integration of
best practices in developing, implementing, and
evaluating malaria communication interventions
at country level
• Advocate for the development and implementation
• Advise and exchange with other relevant RBM
• Advocate for more financial resources to
• Develop a monitoring and evaluation system to
of evidence-based country-level communication
strategies
implement malaria communication interventions
• Disseminate approaches for scaling up effective
communication interventions
• Provide countries and partners with technical
mechanisms on matters pertaining to in-country
communication
monitor progress, ensure targets are met and
communication is demonstrating its value to
meeting the goals and targets set out in the
Strategic Framework
advice and helpful tools for the implementation of
the Strategic Framework
View from under a conical LLIN, which can be hung from a single point of contact.
Conclusion — Actions and Indicators
PAGE 35
CONCLUSION
Actions and Indicators
Global malaria policy makers, NMCPs, and partners
must ensure communication is a funded, core
component of any malaria control strategy and that
communication is effectively planned, implemented,
evaluated, and revised based on evidence and best
practices. This Strategic Framework has outlined
principles and actions towards meeting this
overarching goal. Partners are urged to take the
following key actions:
• Advocate for systems and programs that ensure
•
•
•
•
communication is positioned appropriately within
the global RBM Partnership
Ensure all national malaria control program
communication strategies are contextappropriate, evidence-based, and results-driven
Foster capacity building in communication
planning, management, and evaluation at the
global, regional, national, and sub-national levels
Invest adequate resources to ensure
communication interventions achieve measurable
results at the country level
Expand the evidence base demonstrating
communication intervention impact on social
and behavioral change and thus contribute to the
reduction of the burden of malaria
Four overall indicators are proposed for the next fiveyear period as appropriate measures of progress:
• NMCPs in 80% of high-burden countries have
•
•
created and implemented evidence-based,
national communication strategies
80% of high-burden countries are routinely
allocating resources in their malaria control
budgets to communication interventions
RBM communication partners regularly generate
and disseminate evidence of communication
impact including for priorities outlined in an
agreed on global communication research agenda
Communication activities should be
integrated into National Strategic Health
Plans, malaria business plans, and education
programs from the very beginning.
— Global Malaria Action Plan
• Within one year, the RBM Partnership has
established a community of practice and database
that maps partners in the majority of high-burden
countries in order to facilitate partner collaboration
Progress towards these indicators will be tracked
through annual technical reviews commissioned
to analyze progress in national capacity building
in health communication. International, regional,
and national consultations are proposed to
document and disseminate good practices, lessons
learned, and evidence to date. Highly experienced
communication partners will participate in regular
technical advisory missions, which will offer further
opportunities for NMCPs to assess national and subnational communication activities. Country-level
communication initiatives will develop participatory
monitoring and evaluation processes, including
appropriate indicators and reporting systems, which
will provide the basis for building the evidence
base regarding good practices. These processes
will contribute to improved understanding of how
effective country-level communication contributes to
malaria control.
Resources are necessary to support these actions
and processes. Partners at all levels are urged to
provide appropriate support to this crucial component
of the global malaria control effort.
Annex: Communication Toolkits and Resources
PAGE 37
ANNEX
Communication Toolkits
and Resources
This annex is a list of resources that may be helpful to communication planners
and NMCP program managers. A few of these have been designed explicitly
for malaria communication, but all are potentially relevant in developing,
implementing, and evaluating a communication intervention for malaria control.
The materials listed here are designed to provide an overview of the wealth of
resources that are available.
Diagnostic and Planning Tools
Alliance for Malaria Prevention Toolkit provides
well-documented guidance, resources, and tools
focusing both on campaigns and on continuous
LLIN distribution systems. It describes overall
campaign planning and implementation, including
the importance of establishing coordination
structures, procurement, logistics, communication,
M&E, and reporting.
http://www.allianceformalariaprevention.com/resources/
AMP%20Toolkit%202.0%20English%20FINAL.pdf
RBM Advocacy Guide is designed to help in efforts
to advocate to others about the Roll Back Malaria
partnership and advocate for political and
financial resources.
http://www.rbm.who.int/cmc_upload/0/000/012/558/
advocacy_report.pdf
An Introduction to Advocacy: Training Guide
introduces the concept of advocacy and provides a
framework for developing an advocacy campaign.
It is designed primarily for use in training sessions
but can also be used as a self-teaching device. This
guide was developed by the Academy for Educational
Development (now FHI 360).
http://www.globalhealthcommunication.org/tools/15
BEHAVE Framework is a tool for planners that
emphasizes the need to place the audience at the
center of planning and the importance of focusing on
key factors, or behavioral determinants, in designing
a communication program. It was developed by the
Academy for Educational Development (now FHI 360).
http://www.childsurvival.com/documents/workshops/
BEHAVE!/BEHAVE1.cfm
CDCynergy, a multimedia CD-ROM used for
planning, managing, and evaluating public health
communication programs, does not regard
communication alone as the panacea to public
health but places it in the larger context of issues
and suggests strategic options to choose from and
a comprehensive plan to implement an identified
strategy. It was developed by the U.S. Centers for
Disease Control.
http://www.cdc.gov/healthcommunication/CDCynergy/
The Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE 38
Socio-Ecological Model
*These concepts apply to all levels (people, organizations, and institutions).
They were originally developed for the individual level. Source: Adapated
from McKee, Manoncourt, Chin, and Carnegie (2000)
C-Modules: A Learning Package for Social and
Behavior Change Communication for facilitated,
face-to-face workshops on SBCC, is designed
for staff of development programs in small- and
medium-sized organizations with varying degrees
of experience in planning or implementing SBCC
programs. C-Modules were developed in 2012 and
include a practitioner’s handbook, a facilitator’s
guide, and additional resources. C-Modules contains
five parts: understanding the situation; focusing and
designing; creating; implementing and monitoring;
and evaluating and replanning.
http://c-changeprogram.org/focus-areas/
capacity-strengthening/sbcc-modules
COMBI Design Process is a series of steps to design a
strategy for social mobilization that aims to garner all
personal and societal influences on individuals and
families to encourage them to adopt healthy behavior
and maintain it. COMBI draws on people-centered
approaches in the fields of health education and
communication that aim at changing behaviors.
http://change.comminit.com/en/node/200910/capacity
Communication for Development. In UNICEF,
Communication for Development (C4D) is defined as
a systematic, planned, and evidence-based process
to promote individual behavior and social change that
is an integral part of development programs, policy
advocacy, and humanitarian work. C4D uses dialogue
and consultation with and participation of children,
their families, and communities. Communication for
Development: Strengthening the Effectiveness of the
United Nations is available at:
http://www.c4d.undg.org/what-c4d
Making Health Communication Programs Work:
A Planner’s Guide offers a practical overview to
the health communication process and delves into
the following four stages: planning and strategy
development; developing and pretesting concepts,
messages, and materials; implementing the
program; and assessing effectiveness/making
refinements. This guide was developed by the
National Institutes of Health.
http://www.cancer.gov/PDF/
41f04dd8-495a-4444-a258-1334b1d864f7/Pink_Book.pdf
The P Process, developed by JHU-CCP, guides
public health practitioners in designing successful
communication strategies for a range of public
health issues, such as HIV prevention, child
survival, and maternal mortality. First introduced
in 1982 and updated in 2003, the P Process
involves five main steps: analysis; strategic design;
Annex: Communication Toolkits and Resources
PAGE 39
development and testing; implementation and
monitoring; and evaluation and replanning. The
P Process encourages participation of stakeholders
at all levels of society and capacity strengthening at
the institutional and community levels.
http://www.jhuccp.org/sites/all/files/
The%20New%20P-Process.pdf
SBCC Capacity Assessment Tool (SBCC-CAT)
is the first of a group of Capacity Strengthening
Measurement Tools that assist organizations in
measuring their efforts to strengthen capacity in
SBCC. SBCC-CAT has three versions — one for
organizations to measure their technical capacity and
needs in SBCC, a second for donors and networks
to assess their own capacity and that of the partners
they support and manage, and a third to measure
changes in individual SBCC capacity.
http://c-changeprogram.org/resources/
sbcc-capacity-assessment-tool
Additional Planning Resources
Audience Participation Based Message Design
emphasizes the need to assess the topic of a
campaign and the lifestyle of audience(s) in detail to
choose the medium of communication. It lays down
steps to set goals and measure impact for future
use. It was featured in Development Communication
Report 79.
http://change.comminit.com/en/node/200880
Community Driven Development Principles are
a set of principles to empower people, entrust
responsibility and decision making to them, and
make institutions more accountable to them. It was
developed by the World Bank.
http://www.stoptb.org/assets/documents/getinvolved/
resmob/Community%20Driven%20Development.pdf
Community Problem Solving Network is an online
space that gives people and institutions a platform to
facilitate work on a wide array of developmental and
social issues. It offers strategy tools, program tools,
and a community for information sharing.
http://www.community-problem-solving.net/cms/
FHI 360’s Process for Building a Communications
Capacity is a detailed flow chart that enumerates
steps to match goals and objectives of an organization
with its external and internal environment, with the
aim of building communications capacity. It was
developed by the former Academy for Education
Development (now FHI 360).
http://www.globalhealthcommunication.org/tools/29
How to Mobilize Communities for Health and
Social Change. This guide is designed for use
by health program directors and managers of
community-based programs who are considering
using communication mobilization at the
individual, family, and community levels. This
guide was developed by JHU-CCP.
http://jhuccp.org/node/1256
Theory-at-a-Glance: A Guide for Health
Promotion Practice provides information and
examples of influential theories of health-related
behaviors, the processes of shaping behaviors,
and the effects of community and environmental
factors on behavior. This guide was developed by
the National Cancer Institute.
http://www.nci.nih.gov/PDF/
481f5d53-63df-41bc-bfaf-5aa48ee1da4d/TAAG3.pdf
UNICEF Communication Strategy for
Development Programs, developed by the
UNICEF Bangladesh Program Communication
Coordination Team, guides the actual writing of a
communication strategy for programs to achieve
their development goals, especially their social
and behavioral objectives. The tool explains the
ACADA model (Assessment, Communication
Analysis, Design, Action) that has been developed
by UNICEF to link the use of systematicallygathered data to design a communication strategy
for a development problem. The tool encourages
participatory programming with partners. It is
divided into two main parts: doing the analysis and
developing the strategy, and addressing the actual
development of the strategy.
http://www.unicef.org/cbsc/files/
Writing_a_Comm_Strategy_for_Dev_Progs.pdf
Designing for Behavior Change Guide is designed as
a six-day training to build the capacity of NGO staff
to plan, implement, monitor, and evaluate effective
behavior change strategies. This guide was developed
by the Academy for Educational Development (now
FHI 360) and the CORE Group.
http://www.coregroup.org/storage/documents/
Workingpapers/dbc_curriculum_final_2008.pdf
The Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE 40
Communication Program Planning Worksheet is a
format that systematically breaks down a project into
subcomponents such as identification of partners,
identification of problem, target audience, secondary
target audience, communication goals and objectives,
communication channels, evaluation, etc. This
approach was developed by UNICEF.
http://www.stoptb.org/assets/documents/getinvolved/
resmob/Communication%20Programme%20
Planning%20Work%20Sheet.pdf
EvaluLEAD Framework is an approach to design and
understand evaluation of leadership development
programs. It stresses flexibility in evaluation
design while listing two broad types of evaluation
approaches, three levels of effects of leadership
development intervention outcomes, and six domains
of outcome elements. This approach was developed
by the Sustainable Leadership Initiative.
http://www.phi.org/pdf-library/EvaluLEAD.pdf
Population Leadership Program (PLP) Leadership
Framework was designed for global health
programs of USAID and draws on theories in
transformational leadership.
http://change.comminit.com/en/node/201159
A Field Guide to Designing a Health Communication
Strategy provides practical guidance to those who
are in a position to design, implement, or support
a strategic health communication effort with an
emphasis on developing a comprehensive, long-term
approach to health communication that responds
appropriately to audience needs. This guide was
developed by JHU-CCP.
http://www.jhuccp.org/pubs/fg/02/index.shtml
Engaging Partners and
Facilitating Groups
Participatory Change: Ten Steps in Supporting
Grassroots Rural Development is a list of steps to
ensure greater and more meaningful participation of
local communities in designing and bringing about
social change. This approach combines developments
in the fields of community organization, popular
education, and participatory development. It was
developed by the Centre for Participatory Change.
http://www.cpcwnc.org/
Planning Together: How (and How Not) to Engage
Stakeholders is a tool that lays down scenarios
and caveats (in the form of a matrix) to help
ensure that participation is meaningful and that
proceedings are democratic instead of becoming
a tool for the powerful. It was developed by
Community Problem Solving.
http://www.communitybuilders.ro/library/manuals/
planning-together-how-and-how-not-to-engagestakeholders-in-charting-a-course-by-xavier-desouza-briggs/view
Involving Local Individuals and Groups is a
list of steps to involve local communities and
individuals in projects and activities. This could
help create a better understanding of the needs
of a community and assist in garnering the
support of the local community.
http://erc.msh.org/mainpage.cfm?file=2.2.10.htm&
module=health&language=English
International HIV/AIDS Alliance 100 Ways to
Energize Groups is a compilation of energizer games
and icebreakers to use in workshops, meetings, and
the community to encourage participation in practice.
http://www.aidsmap.com/en/docs/pdf
Energisers2002%28English%29.pdf
UNICEF Games and Exercises is a manual for
facilitators and trainers involved in participatory
group events. This is a book full of games and
exercises grouped around areas such as team
building, conflict management, gender analysis,
creativity, or evaluation.
http://www.unssc.org/web/images/downloads/
Games%20&%20Exercises%20VIPP%20UNICEF.pdf
UNICEF VIPP: Visualization on Participatory
Programs explains how to facilitate and visualize
participatory group processes, with helpful guidelines
that can be applied to various aspects of learningcentered facilitation.
http://www.southbound.com.my/vipp
The “A” Frame for Advocacy gives a step-by-step
guide to advocacy approaches. This is for civil society
actors and health planners to use when designing
advocacy campaigns. It was developed by Johns
Hopkins University in partnership with USAID.
http://www.infoforhealth.org/pr/advocacy/index.shtml
Annex: Communication Toolkits and Resources
PAGE 41
Project HOPE—Seven Steps for Planning a
Community Initiative is a step-by-step guide to
identify problems confronting a community and build
the capacity of the community to design and launch
an initiative.
http://www.comminit.com/en/node/201063
Civil Society Planning Toolkits, developed
by CIVICUS, is a set of tools aimed at helping
organizations get up to speed on a variety of issues,
starting with writing skills and going on to developing
media, handling media, planning, evaluating,
controlling finances, and budgeting.
http://www.civicus.org/component/search/
?searchword=planning+toolkit&ordering=newest&
searchphrase=all&limit=100
Monitoring and Evaluation
A Guide for Monitoring and Evaluating PopulationHealth-Environment Programs encourages program
M&E to improve the quality of work in the populationhealth-environment area. The guide provides a
listing of the most widely used M&E indicators for
population-health-environment programs. This guide
was developed by MEASURE Evaluation/USAID.
http://www.cpc.unc.edu/measure/tools/
other-health-related-programs
Essentials for Excellence is an M&E guide that
provides straightforward answers to often complex
questions (including sampling, research design, and
pre-testing), provides handy tips, and practical advice.
Although the guide focuses specifically on Pandemic
Flu and Avian Influenza, suggestions are meant to be
adapted to suit each user’s circumstances and needs.
The guide was produced by UNICEF.
http://www.unicef.org/eapro/activities_9663.html
Qualitative Research for Improved Health Programs:
A Guide to Manuals for Qualitative and Participatory
Research on Child Health, Nutrition, and
Reproductive Health is a guide designed for program
managers, researchers, funders of health programs,
and others who are considering using qualitative
research methods to help them design more effective
health programs and/or evaluate the strengths and
weaknesses of existing programs. This guide was
developed by Johns Hopkins University Bloomberg
School of Public Health.
http://globalhealthcommunication.org/tool_docs/67/
qualitative_research_for_improved_health_programs__a_guide_.pdf
Monitoring and Evaluating Advocacy: A Scoping
Study sets out to document the various frameworks
and approaches that international agencies are using
to assess the value of their advocacy work. The report
draws on a large body of literature as well as firsthand interviews and discussions. The report does
not attempt to evaluate the various frameworks.
It sets out to draw together a body of knowledge
without passing judgment on the merits or demerits
of various approaches. This study was developed by
ActionAid.
http://www.g-rap.org/docs/monitoring_and_evaluation/
Chapman-Wameyo%202001%20M&E%20on%20
Advocacy.pdf
Training in Qualitative Research Methods for PVOs
and NGOs is a set of training manuals (a trainer’s
guide and participant’s manual) designed to promote
the systematic use of qualitative methods by PVOs
and NGOs to help plan and manage community health
programs. This document was developed by the
Johns Hopkins University Bloomberg School of Public
Health/Center for Refugee and Disaster Studies.
http://www.jhsph.edu/refugee/publications_tools/
publications/qualresearchtrain.html (Curriculum)
http://www.jhsph.edu/refugee/publications_tools/
publications/qualresearch.html (Participant Resources)
Other Online Resources
President’s Malaria Initiative SBCC Repository
showcases communication materials developed by
USAID/President’s Malaria Initiative (PMI) partners
working in PMI target countries in sub-Saharan
Africa. Technical staff working in malaria can view,
download, contribute to, and share communication
materials. The strategies, research, testing, and
evaluation documents related to those materials are
also included. The ambitious PMI coverage targets
can only be achieved through a coordinated approach
with a broad partner base, at both the country and
international levels.
http://www.c-hubonline.org/collections/pmi.html
The Strategic Framework for Malaria Communication at the Country Level: 2012-2017
PAGE 42
JHU-CCP’s Malaria Gateway allows health
professionals to search a collection of 65 carefully
selected websites to find relevant and reliable
information. Sites include the CDC, the Global Health
Council, the Pan American Health Organization, the
PMI, RBM, UNICEF, the World Bank, and WHO.
http://www.k4health.org/resources/malaria_gateway
C-Channel is an e-newsletter that presents a
selection of recent, peer-reviewed journal articles
about SBCC around family planning, reproductive
health, HIV and AIDS, malaria, maternal health
and antenatal care, and social and gender norms.
Subscribe at:
http://sympa.healthnet.org/wws/subscribe/c-channel-iw
Soul Beat Africa: Malaria is a knowledge sharing
system focused on SBCC for malaria prevention,
control, and treatment in Africa, supported by the
President’s Malaria Initiative and its partners. The
site features examples of quality, effective SBCC
information, including research findings; strategies;
implementation reports; tools, materials, and
multimedia products; and training opportunities.
http://c-changeprogram.org/news/
launch-soul-beat-africa-malaria-onlineresource-sbcc-malaria-practitioners
Communication Initiative (CI) Network is an online
network for development where users can get
information by region, health sector, and program
area. It has a variety of newsletters that can be
subscribed to online.
http://www.comminit.com/global/spaces-frontpage
C-Capacity: Capacity Strengthening Online Resource
Center highlights resources and opportunities to
strengthen capacity in social and behavior change
communication.
http://www.comminit.com/c-change-orc
Center of Excellence at the University of
Witwatersrand School of Public Health, South
Africa, has launched a concentration in SBCC
within its Masters in Public Health program.
This is supported by USAID through C-Change
and other donors.
http://www.wits.ac.za/academic/health/
publichealth/postgraduateprogrammes/
10579/masterofpublichealth.html.
For information on the short courses please visit:
http://www.wits.ac.za/academic/health/
publichealth/10545/shortcourses.html
C-Picks presents implementation experiences,
evaluations, strategic thinking, and tools and
resources relevant to SBCC that have been selected
by C-Change from the CI Network’s overall
knowledge base.
http://www.comminit.com/c-change-picks/user/register
USAID Global Health E-Learning Center offers a
menu of courses that learners can use to expand
their knowledge in key public health areas and to
access important up-to-date technical information.
This course is part of USAID’s global health learning
platform where learners can complete training
courses at no cost.
http://globalhealthlearning.org/login.cfm
Bibliography
PAGE 43
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Notes
Photo credits and releases:
The authors are grateful to all of the organizations and individual photographers
who granted permission for their photos to be used in this publication. Permission to
reproduce any of these photos can only be granted by the original owners.
Cover photos:
Top—©Martin Enos/Tanzania House of Talent; Bottom (left to right)—(1) ©RTI
Tanzania; (2) ©Tanzania National Malaria Control Programme (NMCP) Ministry of
Health and Social Welfare; (3) ©Maggie Hallahan, Sumitomo Chemical; (4) ©RBM
Partnership.
Text photos:
Page viii—©Catherine Karnow, courtesy of Malaria No More; page ix—©2007
Bonnie Gillespie, courtesy of Photoshare; page x—©2005 Arturo Sanabria, courtesy
of Photoshare; page1—©Tanzania National Malaria Control Programme/Ministry
of Health and Social Welfare (NMCP); page 2—©FHI 360; page 3—©2011 Cameron
Taylor, courtesy of Photoshare; page 4—©FHI 360; page 6—©The Global Fund;
page 7— ©Joan Schubert; page 9—©Andrea Brown; page 11—©Fid Thompson;
page 12—©FHI 360; page 13—©2006 Alfredo L. Fort, courtesy of Photoshare;
page 14— ©Tanzania NMCP; page 15—©FHI 360; page 16—©Tanzania NMCP;
page 19—©2010 JHUCCP, courtesy of Photoshare; page 21—©FHI 360;
page 24—©2007 Hannah Koenker, courtesy of Photoshare; page 25—©Malaria No
More; page 26—©Catherine Karnow, courtesy of Malaria No More; page 28—©Diana
Mrazikova; page 30—©Maggie Hallahan, Sumitomo Chemical; page 31—©Martin
Enos/Tanzania House of Talent; page 33—©FHI 360.
The Roll Back Malaria Partnership
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World Health Organization
20, avenue Appia
1211 Geneva 27
Switzerland
informbm@who.int
www.rollbackmalaria.org